1983, 07-07 Permit: 83A-6264 ResidencePLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, W.4SHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
LOT BLOCK I SUBDIVISION ILEGAL DESCRIPTION:
2. 111Lt/�Y
OWNER
3. MA -25-40 13cs. z -Ore as
MAILING ADDRESS
W, 3010 RIANoykE
CONTRACTOR
4. cmc
ADDRESS
Ski iM'E
DESIGNER
5
PHONE PHONE
tr
ZIP
4C(z
LICENSE EXPIRES PHONE
ZIP
PHONE
Actual Set Backs in Feet to:
'��
ZIP
Main Floor� Upper
North
South
East (S
Wast j 1
Size of Parcel
Zone Classification
Residential Ne
SOX
I �j 0
jZ_I
TO
Commercial C
Type Const.
Fin. Basement
I Occupaocy
6.
Sprinklered
7N[�
DATE ISSUED' — PERM, -4C. 6.4 z '` 4 0 9' 0 0 0 -iAL
12-.5
rv%,-1
❑Yes
❑No ❑Req'd.
New Const. Valuation
Remodeled Valuation
No. Dwellings
Total Bldg. Floor area
I
7. OF ❑ OTHER
7,
ADDRESS
ZIP
Main Floor� Upper
Floors
Garage/Storage
Greenhouse
CL
Q
Other (Specify)
VLU
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
WHEN MACHINE VALIDATED IN THIS SPACE,
—
DATE ISSUED' — PERM, -4C. 6.4 z '` 4 0 9' 0 0 0 -iAL
—
._.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE �(t EW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
I
7. OF ❑ OTHER
L,'/
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi.ofExempt.
Required
Yes❑ NOV'Number
or Variance
Received
Yas❑ No F-1
DESCRIBEu/ORK
8•
Shorelines/ Flood Hazard
Plans Required
tE> 1 0
v j —C C(wj--
Yes Not Applic. ❑
Received p1l
VALUATION
I SOURCE
OF
GAS
ELECTRIC
I WATE
PUBLIC
SEWAG
SEPTIC
Ownership
/
FEES COLLECTED
9 < 1.
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private
I 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
4�oG 00
work will be complied with whether specified herein or not. The granting of a permit does not presume to 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 APPLICATION
OWNER OR AGENT sf ' l DATE
Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
tngmeer
Utilities
SEPA
Planst;' PERMIT IS NONTRANSFERABLE
Exam. fJ PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
e h mg IN 180 DAYS
Plan Check
PERMIT NUMBER
SEPA
Modular/
MFG.Home
y.
CL
Q
Other (Specify)
VLU
J_
LL
TOTAL AQa
$
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED' — PERM, -4C. 6.4 z '` 4 0 9' 0 0 0 -iAL
0
.APV S