1983, 03-22 Permit: 83A-2114 ResidencePLAN NUMBER _ APPLICATION /PERMIT
3.� SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 611 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
MaiA Upper
iD
1. srR . t � 117
I
Garage/Store
r `Y
PARCEL NO. � r�i I
goo
2 LQT
BLoftc
SU
Iv I
'1111SION 01
t5�Z. I�
1�
LEGAL DESCRIPTION:
TO
OWN4R
P O
PHONE
Unfin.Bas(
6.
-.
MAILING ADDRESSYF
j.
i
IP
Actual Set Backs in Feet to:�j
C
10
-
No. Dwelling
-:�
North South J r% East
West
CON�
7. ❑OTHER
2BLD.
LICENSE EXPIRES
PHONE
Size of Parcel
!'71Q
Zone Classification
Residential
Commercial ❑
4. ADDRESS
Certifi.ofExempt.
Required
ZIP
Type„
Number
u
Sprinklered
Received
Yea❑ No❑
8. DESCRIB W R
Shorelines/ Flood Hazard
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
NewConst. t.Valuation'emodeled
Valuation
Total Bldg. Floor Area
5.
GA9
IELECTRIC
PWATEUBLICR
'G�
Ownership
ADDRESS
ZIP
MaiA Upper
Floors
Garage/Store
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Dock
Fin. Basement
Unfin.Bas(
6.
-.
TY PE
Y W ❑ ALT. ❑ AWN. ❑ RPL. ❑ MVE.
TOF
No. Bat No.
�`
Floors
11-3WORK
No. Fin. ms
No. Dwelling
-:�
7. ❑OTHER
2BLD.
❑ PLMB. ❑ MECH. ❑ M. H. ❑ POOL
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yea❑ No❑
8. DESCRIB W R
Shorelines/ Flood Hazard
Plans Required
yes Not Applic. ❑
Received
VALUATION
I SOURCE
GA9
IELECTRIC
PWATEUBLICR
SEPTIC SEWAGE
Ownership
COLLECTED
9•
UTILITIES
PRIVATE ❑
SEWER Ua'
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
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�� CATlON
OWNER OR AGENTy DATE0
Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Env. Health
Planning
Prevent.
Engineer
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
fir -1 PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. /
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PERMIT NUMBER
_. 1 i
TOTAL $ I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES Aop PERMIT. 1
DATE ISSUED _ J PERMIT NO l z * 4 0 9 0 0
.790�AL
s 7- gh 4 r
/;l 10 /4 O 1$1 e- oc AJ O 4-0,), i70/(/
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y - s
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