1982, 12-17 Permit: 82B-1996 InsertPLAN NUMBER APPL ICAT ION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, %ASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREETADDRESS _ PARCEL NO.
C 13 11 ? 3 _3 1Si-
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER
PHONE- t�+h
PHONE ""�k
3 N � . G K,
Zz - z � � s
B 2-f!6 It
3.
-Z6'
MAILING ADDRESS
-�S s
ZIP
Actual Set Backs in Feet to:
5- ( Z-�-, j
� (XI
North South East
West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
sArWE
I
I
Commercial ❑
4.
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE W ❑ ALT. ❑ AD` N.
❑ RPL. ❑ MVE.
7 OF
El OTHER
WORK El BLD. ❑ PLMB. MECH.
❑ M. H. El POOL
Certifi. of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ Noll
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
8• (rdZo-
Yes El Not Applic. ❑
Received ❑
VALUATION
I SOOURCE
GAS
ELECTRIC
PUBLIC 11SEPWATER
TIC ❑
Ownership
FEES COLLECTED
9•
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
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 REVER E SIDE FOP KOUIRED
INSPECTIONS
Plumbing
SIGNATURE OF
APPLICATION / -- �f
OWNER OR AGENT
DATE /
Mech.
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Utilities
SEPA
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plans PERMIT IS NONTRANSFERABLE
Exam. xl;ERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
BuildingI'msal IN 180 DAYS
Tech. `ile"
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PERMIT NUMBER
Sz. a (019
TOTAL $ 10 I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
p b99.6z *20. 0
DATE IS ll b- 17 -8 2 PERMIT N TOTAL