1983, 09-08 Permit: 83A-8775 ResidencePLAN NUMBER APPLICATION/PE. fi IT
SPOKANE COUNTY — DEPARTMENT OF WILDING & SAFETY
�7 NORTH 811 JEFFERSON / SPOKANE, WASHF .3TON 99260 / (509) 456-3675
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
APPLICANT: COMPLETE NUMBERED SPACES -
PRESS HARD TO MAKE 3 COPIES
Number
MFG. Home
STREET ADDRESS
Received Yes -1 Noh
PARCEL NO.
DESCRIBE WORK
8•
Shorelines/ Flood Hazard
1.
I- • 1z�k�
z7�43
,zzzz
I SOOUFCE
GAS
LOT
BLOCK
SUBDIVISION
Ownership
LEGAL DESCRIPTION:
FEES COLLECTED
9•
2.
•Z_Z
I
PRIVATE ❑
4T+\
Public O Private V
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
OWNER
PHONE
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
PHONE
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SID FOR REQUIRED INSPECTIONS
Plumbing
r_(2_,c s. nn C) .<_� '�
q
OWNFR OR AGFNT� �� . o,.�.r�� _ _ DATE
\:a. (
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
North South 1
East COU' West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential
4
12CZ� . ���
�\
Commercial ❑
ADDRESS
ZIPT
nst.
Occupancy
Sprinklered
�
[-]yes❑No
IReq'd.
DESIGNER
PHONE
NConst. Valuation
Remodeled
Valuation
Total Bldg. Floor Area
24 -
5.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
160-Z I
`-•
6-712
---'
CHANGE OF USE FROM
TO
Cmer Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
—
--
ieDi
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ALT. ❑ AD' N. ❑RPL.
❑ MVE.
7
OF
❑ OTHER
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi. of Exempt.
Required Yes 17 NoU
Number
MFG. Home
or Variance
Received Yes -1 Noh
CL
DESCRIBE WORK
8•
Shorelines/ Flood Hazard
Plans Required F
-N(,Lf— v"V%.L4 --p"
Yes El Not Applic. ❑
Received
VALUATION
I SOOUFCE
GAS
ELECTRIC
I
pU8 ICATERCLI
SEPTISEWAGE
Ownership
FEES COLLECTED
9•
UTILITIES
PRIVATE ❑
SEWER
Public O Private V
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
4,7 ,pG
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 SID FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF `' APPLICATION
q
OWNFR OR AGFNT� �� . o,.�.r�� _ _ DATE
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
N
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans�/ PERMIT IS NONTRANSFERABLE
Exam. � PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech.ing IN 180 DAYS
Plan Check
PERMIT NUMBER
LA 7
SEPA
Modular/
MFG. Home
CL
O
Other (Specify)
C)
W
J
LL
TOTAL
$2
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Q 7 7
DISS
ATEUED' 8-" 3 PERMI�?JO. /. 5 z *4 4 2.0 O 0CJTAL