1983, 03-18 Permit: 83A-2002 ResidencePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PRELIM. FINAL DATE
Env. Health
Planning
Engineer
"31
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam./ PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech ing , IN 180 DAYS
SEPA
Modular/
MFG.Home
Other (Specify)
PERMIT NUMBER
„fi!71
-
9
J
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
7' 2` 0,2z *421�0G°�
DATE I ED PERMIT NO. TOTAL
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1 . STREET ADDRESS
HONE
PARCEL NO.
Residential
Commercial ❑
2 L
B K
SUVISION �G
�� j�f���
7 a ►19
LEGAL DESCRIPTION:
OWyER � a,!
C��
3.
P ONEIV
' z
PHONE
MAI ING AD RESS
1 0� /
4 �i V
Type(�on t.
�z j
/ 1
Actual Set Backs in Feet to:
North South East
1 West %
PRELIM. FINAL DATE
Env. Health
Planning
Engineer
"31
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam./ PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech ing , IN 180 DAYS
SEPA
Modular/
MFG.Home
Other (Specify)
PERMIT NUMBER
„fi!71
-
9
J
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
7' 2` 0,2z *421�0G°�
DATE I ED PERMIT NO. TOTAL
CONT A TO tom,
LICENSE EXPIRES
HONE
Size of Parcel
ZonneeClassifi tion
r
Residential
Commercial ❑
4
V
ADDRESS
ZIP
Type(�on t.
upancy
Sprinklered
�J
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Consl. Valuation I
Remodeled Valuation
Total Bldg. Floor Area
I
5.
ADDRESS
ZIP
Min r Upper
Floors
GaragelStorag�
Greenhouse._
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
in. Basement
U fin, Vent
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE N W ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7.
OF ❑ OTHER
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M. H. El POOL
ayarianExempt.
Required
Yes❑ No❑
Number
Received
Yes❑ No❑
DES ORK
?
Shorelines/ Flood Hazard
Plans Required
8.
7
Yes Not Applic. ❑
Received
VALUATION
SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIC
SEWAGE
SEPTIC ❑
Ownership
/f
FEES COLLECTED
9
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
�, j
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 / —/ 7 r
A-
` �
Mech.
OWNER OR AGENT "� DATE L: -J
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env. Health
Planning
Engineer
"31
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam./ PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech ing , IN 180 DAYS
SEPA
Modular/
MFG.Home
Other (Specify)
PERMIT NUMBER
„fi!71
-
9
J
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
7' 2` 0,2z *421�0G°�
DATE I ED PERMIT NO. TOTAL
L .q Q 1
T
:r