1983, 04-06 Permit: 83A-2682 Residence--7PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
r✓7? SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY - z� 8'Z'
{ NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRES$ HAR`) TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. �i 1 'tA,DiLc'"rnC%d+� }�.�+D1�.Cr•.i
OWNER PHONE PHONE
1 77Z_�2
3•
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to: 11
„ r 9 .21
'�
�{p
North South75C.3 East
West
CONTRACTOR LICENSE EXPIRES
PHONE
Size of Parcel
�a
Zone Classification
Z -_ 1
Residential
Commercial ❑
t �f%
4,
ADDRESS
ZIP
Type Const.
R upa cY
�J ,n,.'
Sprinklered
❑Yes ❑No ❑Req'd.
5-14
PHONE
Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
DESIGNER
G+
ZzsC,
5.
ADDRESS
ZIP
Main Floor Upper
Floors
GaragelStorage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
CHANGE OF USE FROM
TO
6.
l
No. Baths No.
Floors
No. Fin ms
No. Dwellings
J
TYPE N NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
2w 1
1
90
7•
OF I/BLD.
BLD. ❑ PLMB. ❑ MECH. ❑ M. H. El POOL
orVaarianExempt.
Required
Yes❑ No
Number
WORK U°
Received
Yes El No❑
DESCRIBEAVORK
Shorelines/ Flood Hazard
Plans Required
8.
`-->r � , fNL.4
J+ "c F
Yes ❑ Not Applic. ❑
Received
VALUATION
SOURCE
GAS ELECTRIC
WATER
PUBLIC
SEWAGE
SEPTIC
Ownership
Public ❑ Privat
FEES COLLECTED
9•
LI
UTILITIES
PRIVATE ❑
SEWER iC
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
Building
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 a y other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR UIRED INSPECTIONS !�
Plumbing
APPLICATION
SIGNATURE OF r
OWNER OR AG DATE
Mech.
OVALSI SPECIA6,CONDITIONS: (SEE REVERSE SIDE FOR NO I Ict)
NAL DATE
Env. Health
N
Planning
Fire
Prevent.
Engineer
Utilities
Plansr PERMIT IS NONTRANSFERABLE
Exam. D PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $7C1 I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEYSSUEIX U— 3 PERMI"6. o' 2 z * 3 7 4 0 0 SAL
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