1983, 03-21 Permit: 83A-2052 ResidencePLAN NUMBER APPL IC:AT ION /PERMIT
PERMITNUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 611 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
6,1 00
PARCEL NO.
r�suCfv;�joN
vO"kco`2OWNE
LEGAL DESCRIPTION:
N
PHONE
'
s
ti 11:1—
MAILING A DRESS
ZIP
Actual Set Backs in Feet to:
'�- - P�•��'V
/
North �lr South East �w West lv
CONTRACT
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Cl ification
Residential ❑
"
4.
>c ! 3
- :
Commercial ❑
G .
ADDRESS
ZIP
Tyi9ronst.
upany
Sprinklered
❑Yes ❑No ❑Req'd.
}
DESIGNER
PHONE
New
nv
Remodeled Valuation
Total Bldg. Floor Area
Co ealuatl
c J
5.
z
` 1 6
ADDRESS
ZIP
Ma�noQr Upper
Floors
Garage/ torSge
Greenhouse
``
; i 17
i
CHANGE OF USE FROM
TO
Coyer peck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
¢
�s
TYPE ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
No. Bath No.
- ��
Floors
No. Fin��ooms
No. Dwellings
�
i
%. OF 11 OTHER
Certifi.ofExempt.
Required Yes❑ No❑
Number
WORK BLD. ElPLMB. ElMECH. ElM.H. 11 POOL
or Variance
Received Yes❑ No❑
DESCRIBE WOK /�'
8. {{��
Shorelines/Flood Hazard;"
Plans Required
Yes❑ NotApplic.
Received
VALUATION
SOOURCE
GAS
ELECTRIC
PUBLIC
SEPTO
Own�hip
FEES COLLECTED
9•
UTILITIES
PRIVATE ElSEWER
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-
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 RE ED INSPECfIONS
Plumbing
SIGNATURE OF APPLICATION 3 �� 7
DATE —
OWNER OR AGENT �!�
Mech.
SPECIAL
A ALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
Fire
MFG. Home
Prevent.
a
O
Engineer
n
Other (Specify)
W
Utilities
LL
TOTAL $
SEPA
THIS SPACE,
WHEN MACHINE VALIDATED IN
Plans
PERMIT IS NONTRANSFERABLE
THIS BECOMES A PERMIT.
Exam.
Building
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
_ j
3
o J
: S 3 9 k U 0 d I
IN 180 DAYS
Tech.
+p
1 12�
DATE ISSUED PERMIT
NO. TOTAL
PLOT PLAN
SCALE:
LEGAL DESCRIPTION: LO s 6 L K 3 m I C i L U wt e 2 L"o
NAME: ren 2qo N F) AcH �2e- S/ % 2 -
ADDRESS:
ADDRESS: /2004- 3R
3.3
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