1983, 08-19 Permit: 83A-7968 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
STREET ADDRESS 'T�► PARCEL NO.
3"7
LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. A - \%t 61iA�`S I::Ofl,TtO►J
OWNER PHONE PHONE
a7d--�
, t
MAILING ADDRESS
TCA
ZIP
Actual Set Backs in Feet to:
,
T, . tZrj
Q�2,0r,
North ZS 1South East West %6,
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential V
AV►�L�
Q -- t+��
'jZ A
Commercial C
4.
ADDRESS
ZIP
Type Const. Occupancy
Sprinklered
Spm
��
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
N Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
_ -4,12-
�12
Z \C
5.
ADDRESS
ADDRESS
ZIP
loot Upper
Floors
Garage/Storage
Greenhouse
;X
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basem
6.
/
TYPE NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
H
No. Baths No.
Floors
i
No. Fin. Rooms
C.
No. Dwellings
7. OF -/ ❑ OTHER
Q'BLD. ❑ PLMB. ❑ MECH. ❑ M.H. 11 POOL
Required
Yes No
Number
WORK
� aiio�fExempt.
Received
Yes❑ No❑
"—
WORK
Shorelines/ Flood Hazard
Plans Required Rr
8. kSCRIBE
�.12n,%0}✓Nc_.F_
Yes❑ Not Applic.❑
Received
VALUATION
I SOURCE
GAS
ELECTRIC
WATE�
SEWAG
Ownership
FEES COLLECTED
9
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Privatev,
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
' 3Roxo
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 can
a provisions of any other state or local law
regulating construction or the performance
of construction. SEE R VE
SE SIDE FOR REQUIRED IN PECTIONS
Plumbing
SIGNATURE OF
APPLICATION
/�
^%A1k1Cn no An_CwI / t�
nATF __ _ —
Mech.
SPECIAL APP ALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. N4AL DATE
Env. Health L __
Planning
Fire
Prevent.
Utilities
SEPA
Plans A�P�yrr�J i�c,th� PERMIT IS NONTRANSFERABLE
Exam. kiA PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PERMITN MBER
--7 I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATASBUEJ 9 843 PERMI71N0.6. 8 0 * 3 9 0. 0 0 �giAL
CL
O
V
W
J
tL
TOTAL $