1983, 07-11 Permit: 83A-6364 ResidencePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
2.
STREET ADDRESS
.101 zi
LOT
BLOCK
APPLICANT: COMPLETE NUMBERED SPACES _PRESS HARD TO MAKE 3 COPIES
PARCEL NO.
Z4654"5-- 44,t
SUBDIVISION
3
OWNER
STc �N
MAILING ADDRESS
tt . ZC€O4.
CONTRACTOR
4. G fwrW
ADDRESS
PHONE
PHONE
ZIP
LEGAL DESCRIPTION: ere r ES
Actual Set Backs in Feet to:
North [South Z
LICENSE EXPIRES
PHONE
Size of Parcel
15 k t36
11 Zone Classification
East I 1 I West ( 0
Residential fie
Commercial ❑
4
ZIP
aazoa
Type Const.
Occupancy
R -) rvt -+
Sprinklered
❑Yes ❑No ❑Req'd.
5.
DESIGNER
PHONE
NstConst. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
1574
Upper Floors
Garage/Storage
2$
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
1 too
Fin.Basement
4N.
Unfin. Basement
14-0
TYPE i6 NEW CI ALT. 1:1 AD' N. CI RPL. El MVE.
7. OF �f BLD.
WORK ❑ PLMB. 1=1MECH. CIM.H. IDPOOL
❑ OTHER
No. Baths
No. Floors
Certifi. of Exempt.
or Variance
No. Fin. Rooms
8
Required Yes❑ Nod.
Received Yes❑ No
No. Dwellings
Number
DESCRIBE WORK
8. T'Avvu _
VALUATION
9.
�S i1�EWC (E
Shorelines/Flood Hazard
Yes CI Not Applic. ❑
Plans Required �d/
Received F
SOURCE GAS
F
UTILITIES
ELECTRIC
WATER _/
PUBLIC L,I
PRIVATE ❑
SEWAGE i
SEPTIC
SEWER ❑
Ownership
Public 0 Private 0
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
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 FIA: • ,3 UIRE sINSP. CTIONS
SIGNATURE OF
OWNER OR AGENT
APPLICATION
DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
ARE r✓\Y ' ZA t b t3
(14
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
4-06
TOTAL $ 40(.0 -CO
PE$MIT UMBER
02* *40600
*406006
A *000
636.3
07-11-83
6479..
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATERS7UEDt 1'- 8 3
PERM IT4r4.6.45 *406.00*IrAL
Comic.
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cop
64
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