1983, 06-07 Permit: 83A-4983 ResidencePLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WAb'AINGTON 99260 / (509) 456-3675 -
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS �J PARCEL NO.
1. � . U '� i' ��? ( - v-7
LOTBLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNERi �� � �. � PHONE ON —
3.
MAILING ADDRESS I
ZIP
Actual Set Backs in Feet to:
MME
North South East
10 West
CQ T TOR
C/✓v �ij
LICENSE EXPIRES
O E
Size of Parcel
IC
ZoneClassif'cati n
Lam:
ResidentialZr
I`
� ��
Commercial ❑
4.
AQDRES$7 I
i�✓
TYPeCgns
vst
.
upan ^ A I
'Re'm'odeled
❑Yes Spr❑Nor� ❑Req'd.
DEESSIGNEIR
PHONE
New
�uuat!on
C7/
Valuation
Total Bldg. Floor Area
5.
(p !/
ADDRESS
ZIP
Main Floor
Upper Floors
Gar
el$tor ge
Greenhouse
CHANGE OF USE FROM
TO
Cover k
Uncv. Deck
--
Fin. Basement
Unfiln. Ba�eme
6.
i✓
v
TYPE
No. Baths
No. FI
No. Fin. Rooms
No. Dwellin
NEW ❑ ALT. ❑ AD'N. ❑RPL. ❑ MVE.
1,5'
I
7• OF 11 OTHER
WORK �LD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi.ofExempt.
Required
Yes❑ No
Number
or Variance
Received
Yes ❑ No ❑
DE
Shorelines/ Flood Hazard
Plans Required
/r✓68.
e
�oI❑
Received
VALUATION
9•
SOURCE
OF
GA
ELECTRIC
I pUBLICR
SEPT CGE
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER
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
Building
work will be complied with whether specified herein or not. The granting of a permit
p p g g p
does not resume to
p 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 IDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
W,
OWNER OR AGENT tA'l DATE
Mech.
SPECIAL APPROVALS
PRELIM. FINAL D
Env. Health
Planning
Fire
Prevent.
®--E
MME
SPECIAL CONDITIONV(t,EE REVERSE SIDE FOR NOTICE)
600--0 "Lt (2 �_��I.- �.Tf4co -:Z-36 H(I
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PERMIT NUMBER
TOTAL $
WHEN MACHINEVALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE'ISSUEd 7—" 3 PERMIA6.8, 3° * 3 9 0, 0 0 g(#AL
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