1983, 02-14 Permit: 83A-1073 Repair Fire DamagePLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. i_. 11?p? zcit r
LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
tt� it izs to c ,A is rz 2 i� cJ
JNER PHONE PHONE
✓Ell ,jw `. rVw NrfcL.Low q ;t$ -I(-00
3. MAILING ADDRESS ZIP Actual Set Backs in Feet to: i lC %'!�F"Ti N4
'C • tCS-7 acv`f t•'t 6(et20c, North South East west
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel ZoneClasSification Residential
1 Commercial ❑
ADDRESS ZIP Ty t. Occu nc Sprinklered
O 2. �`�t�:Ov.s �� �� 1�/ f 1t'1 OYes ❑No ❑Req'd.
DESIGNER PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
�, 5- —7;;L0
5. ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv. Deck Fin. Basement Unfin. Basement
No. Baths No. Floors No. Fin. Rooms No. Dwellings
TYPE IJNEW ElALT. ElAD' N. RPL. ❑ MVE. - —
7. OF_jj ❑ OTHER
BLD. El PLMB. El MECH. 1:1 M.H. ❑ POOL CertifI.ofExempt. Required Yes❑ No / Number
WORK to
or Variance Received Yes❑ Noel
SCRIBE WORK �7� Shorelines/ Flood Hazard Plans Required ❑
8. 1�A I� �t f1( C IAt'P° <: Y 3d Yes Not Applic. ❑ Received ❑
a�VVALUATION SOURCE GAS ELECTRIC WATER SEWAGLIC 0 SEPTIC E Ownership FEES COLLECTED
9• c ,, 00 UTILOITIES 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 Building -75. Cs
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
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 REOUIRED INSPECTIONS Plumbing
SIGNATURE OF �// �!/ APPLICATIOLl
yx '2/�L//� 3 Mach.
ue
AIAr=nO er_I=MT i1.0 I% h DATE 1l��
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
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 $-75-22
PERMIT NUMBER
03A - I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11 p 1 (j 7 0
DATEQSiUi L _ 8 PERMITNO. r' 3 2
* 7 5.0 0 #OirAL