1983, 03-21 Permit: 83A-2061 ResidencePLAN NUMBER - APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
)'2
1 1
.Z V o
p► i� i'Ct a rt1
OWNER
PHONE
PHONE
j
i 4 ` iiCl�
C(],A-2A`=Q
3.
MAILING ADDRESS
ZIP
Actuai,!�et Backs in Feet to:
;
fp,
A61 L(o
N h "IM& South 3d` East
= West 1'3
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
I
Residential IV
A rv►rZ
SS A L-3 c,
-k
Commercial ❑
4.
-'s.
ADDRESS
ZIP
T Const. Occupancy
Sprinklered
4-6*11% YM6
r%1
„'
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
N.9w Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
t+bo
4l
A40
'®-
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE VNEW ❑ ALT. ❑ AD' N. ❑ RPL.
❑ MVE.
Z
1
7.
OFElOTHER
BLD. ❑ PLMB. ❑ MECH. ❑ M.H.
❑ POOL
Certl ii of Exempt.
Required
Yes No
Number
WORK
or
Received
Yes❑ No El
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required/
8.
eL V 111— 0 C
.�?t LE ga ��
Yes❑ Not Applic. ❑
Received f�J
VALUATION
SOU
GAS ELECTRIC
WATER
PUBLIC
SEWAGE
SEPTIC ❑
Ownership /
FEES COLLECTED
9
UTILITIES
PRIVATE ❑
SEWER
Public ❑ Private la
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
;Z
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 SlIfE FOR REOUIR§Q
INSPACTIONS
Plumbing
SIGNATURE OF!f�
AI A I k I CG AO Arl 0 KIT 1.fi.�,�,2 !L
APPLICATION 7;�A)�
DATE
Mach.
SPECIAL APPROVALS SPECIAL CONDWOW (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
� f�G
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans1�
PERMIT IS NONTRANSFERABLE
Exam. j h PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building ee/ / IN 180 DAYS
Tech. 9/fiS/
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
PERMIT NUMBER
S'sp, - 20("l
TOTAL $ a.
WHEN MACHINE VALIDATED IN THIS SPACE,
THISBECOMESA PERMIT.
6, 1DATE (6S &2 1 -8 3 PERMIT N. z k TOTAL
0