1983, 03-16 Permit: 83A-1937 ResidencePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — D►RTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
2• 3 M1( LQME, ZNP
OWNERs PHONE PHONE
3. i w L B iAs ' s
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
--__-SC5
. O. N
D +
North South East '42,1 West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel Zone
Classification
Residential
j(o,•{ y X r— ^-
�—
Commercial ❑
4.
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
V _
—3
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
3 1.� �J
1
5.Yv
ADDRESS
ZIP
Main Flcor Upper
Floors Garage/Storage
Greenhouse
no I
57G I
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. BasementUnfin.
Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE ❑ NEW ❑ ALT. El AWN. 1:1 APL. ❑ MVE.
7. OF ❑OTHER
Certifi. of Exempt.
Required Yes❑ No El
Number
WORK ❑ BLD. ElPLMB. 1:1MECH. 11M.H. 1:1 POOL
orVariance
Received Yes❑ Non
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required
8. z; MILY
Yes Not Applic. ❑
Received
VALUATION
I SOURtE
OF
GAS
ELECTRICWATER
PUBLIC
SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9.
UTILITIES
PRIVATE ❑
SEWER
public El Private ❑
1 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
0
Building 7LL x
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 REOULOD INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT N� DATE jJ
Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Dac-r— W1512- 3:� � �
Env. Health
S�'fk12'r wRrvf rT. ooTiNSs irnr0 CauNn
Planning
13 trtnxe ERM IT rn 64C" 4VALf a &4/40A)
Fire
Prevent. r}PPILDUI+,- OF L
Engineer
Li LANN(/v & DZ pAATA1eMr
Utilities L
Pians PERMIT IS NONTRANSFERABLE
E"a(n' PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building p ,J IN 180 DAYS
Tech.
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify) 01110.
TOTAL $
PERMIT NUK41JER
z
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. z
DATEYSSUED� _ PERMITL O. 3. L * 2 9 6' O O TO AL
I Do, 44I
T 7 L�V
M I D l LO ME 2tiD
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