1983, 07-07 Permit: 83A-6263 ResidencePLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WA§HINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
VVVNF_H
PHONE
PHONE
3.-,,cv -3: ttc pa�2S
Als'Q
MAILING ADDRESS
ZIP
al Set Backs in Feet to:
�� C7 Gi CL iA IV" t 6th
h South �� East
7. West
CONTRACTOR
LICENSE EXPIRES
PHONE
of Parcel
ZoneClassification
Residential
SAmE
4.
1150
—%
Commercial ❑
ADDRESS
ZIP
Const.
Occupancy
Spri nklered
•Q_
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
[No.
5.
ADDRESS
ZIP
n Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
r Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
TYPE l NEW ❑ALT. ❑ AWN. El RPL. ❑ MVE.
Baths No.
Floors TNo.
Fin. Rooms
No. Dwellings
7• OF �/ ❑ OTHER
WORK Lr3BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
ifi.ofExempt.
Required
Yes❑ No
Number
arianoe
Received
Yes❑ No❑
8 DESCRIBL,WORK _
Shorelines/ Flood Hazard
Plans Required El
�AfVtiIL
iC SI"DFPX;E
❑ YesNot Applic.❑
`l
Received LY
VALUATION
9
I SOURCE
GAS
ELECTRIC
PUBLIC
SEP AIC
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑Private
1 hereby certify that I have read and examined this application and have read the "NOTICE"
provisions included on
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
_;W �
work will be complied with whether specified herein or not. The granting of a permit
p p g g p
does not resume to
p give au-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF —rAPPLICATION
OWNER OR AGENT ,
J22&DATE
Mach.
SPECIAL APPROVALS
PRELIM. FINAL D,
Env. Health
'I
Planning
Prevent.
Engineer l
Utilities
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
TOTAL $ 330.00
PERMIT NUMBER
P l
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B%ECOM'7ES A PERMIT. L
DATA 7' r PERMIT U' 3 z * 3 3 0, 0 0 SAL
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