1983, 05-09 Permit: 83A-3808 ResidenceFIBER APPLICATION /PERMIT
,4 " SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
6. CHANGE OF USE FROM
TO
TYPE NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7 OF WORK -kBLD. 13PLMB. 1:1MECH. ElM.H. ❑ POOL ❑OTHER
ZQ ts'ys
No. Baths No. FloorsNo. Fin ooms No. Dwellint
3 j re -1 466 -CL /
Certifi. of Exempt. Required Yes❑ No❑ Number
or Variance
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
�.
STREET ADDRESS
'A
Plans Required ❑
- M1� u !{
PARCEL NO.
Received ❑
VALUATION
SOURCE
OF
F.: 101
3q,�,�.
WATER
PUBLIc,�c
SEWA E
3Zs 1-I - /!Z0
2.
LOT BLOCK
SUB,q�(VISION
t-
PRIVATE ❑
LEGAL DESCRIPTION:
Public ❑Private ❑
FEES COLLECTED
L
�i5b"a c�i. e c -o 5
f
work will be complied with whether specified herein or not. The ting of a permit does not presume to give au-
Building
thority to violate or cancel the provisions of any other state or I a}' law regulating construction or the performance
OWNER e ". -�.
PHONE
PHONE
3.
-" r
v
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM FINAL DATE
Plan Check
MAILING ADDRESS
ZIPua
t Backs - n Feet to:
7
North 9() South -30
East Z U
West
CONTRACTOR
GL- 0 4,
� i NC �-i
LICENSE EXPIRES
D '/V _ 6x 3
PHONE
`%2 -- � i � Z
Size Parcel
t �
Zone Classification
Residential.
4.
cy
U5( t �
S k<<<<- Vii}
iY
Commercial o
ADDRESS
_
ZIP _
//�ic`�3NYt�
TypeCong
y�
Occu ncy
� m
Sprinklered
Oyes ❑No ❑Req'd.
DESIGNER
L
PHONE
ew Const. Valuation
Remodeled Valuation
Total Bid . Floor Area
5.
L l
ADDRESS ✓f/i
v
ZIP
Main Floor
)9,77
Upper Floors
--
Garage/Storage
t�
Greenhouse
6. CHANGE OF USE FROM
TO
TYPE NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7 OF WORK -kBLD. 13PLMB. 1:1MECH. ElM.H. ❑ POOL ❑OTHER
ZQ ts'ys
No. Baths No. FloorsNo. Fin ooms No. Dwellint
3 j re -1 466 -CL /
Certifi. of Exempt. Required Yes❑ No❑ Number
Env. Health
Planning
Utilities
Plans
Exam.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ ` `:t-
w 1
WHEN MACHINE VALIDATED IN TH
THIS BECOMES A PERMIT.
PERMIT NUMBER
DATE ISSUED 0 9 PERMIT NO 0. oz '� 4 4 8' �� TOTAL
d
0
V
W
J
LL
or Variance
Received Yes No❑
DESCRIBE WORK n //� nn _
8.
Du FA^ P-kl�
Shorelines/ Flood Hazard
Plans Required ❑
- M1� u !{
Yes Not Applic. ❑
Received ❑
VALUATION
SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIc,�c
SEWA E
Ownership
9 !).OL% i
UTILITIES
q
X11 {(-
{��jt/i
PRIVATE ❑
SEPTIC
SEWER ❑
Public ❑Private ❑
FEES COLLECTED
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
work will be complied with whether specified herein or not. The ting of a permit does not presume to give au-
Building
thority to violate or cancel the provisions of any other state or I a}' law regulating construction or the performance
of construction. SEE REVE SIDE FOR R QUI INSP C I NS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT �'
DATE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM FINAL DATE
Plan Check
Env. Health
Planning
Utilities
Plans
Exam.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ ` `:t-
w 1
WHEN MACHINE VALIDATED IN TH
THIS BECOMES A PERMIT.
PERMIT NUMBER
DATE ISSUED 0 9 PERMIT NO 0. oz '� 4 4 8' �� TOTAL
d
0
V
W
J
LL