1983, 07-05 Permit: 83A-6126 InsertPLAN 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
1.
2.
STREET ADDRESS
I
LOT BLOCK SUBDIVISION
3
OWNER
f-+ C'7Ul-zR
PHONE
MAILING ADDRESS
E (1q2-1 LI -C.0---
ONTRACT
4. oc�R -jc..4APC Ctii\vatka.4.1 5
ADDRESS
i1Q4
DESIGNER
5.
LICENSE EXPIRES
PHONE
2 C04
ZIP
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 'South
ADDRESS
CHANGE OF USE FROM
6. ,
ZIP
9ZaZ--
PHONE
ZIP
TO
TYPE d'NEW E ALT. ❑ AD . -! RPL. MVE.
7. OF ❑ OTHER
WORK E BLD. ❑ PLMB. MECH. C M.H. C POOL
Size of Parcel
Type Const.
1-1 Zone Classification
East
West
Occupancy
Residential
Commercial :::
Sprinklered
Yes ElNo Reg 'd.
New Const. Valuation
Main Floor
Cover Deck
Remode ed Valuation
Upper Floors
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
Total BIdg. Floor Area
No. Floors
Fin. Basement
Greenhouse
Unfin. Basement
No. Fin. Rooms
No. Dwellings
Required Yes:.] No E.
Received YesE No
Number
DESCRIBE WORK
8. \ Ici
SOURCE
UTILLIITIES
9.
VALUAAON
GAS
ELECTRIC
WATER
PUBLIC C
PRIVATE Cl
SEWAGE
SEPTIC C
SEWER C
Shorelines/Flood Hazard
Yes'.- Not Applic.
Ownership
Public E 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
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 REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVS
PRELIM. FINA DATE
APPLI/4./DATE CATION 7 - S
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
ECIAL CONDIT NS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required
Received
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
—
TOTAL $ -b
PERMIT NUMBER
85 A
04*
*2000
*20.006
*0.00 0
612.52
07-05-83
2 6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE Int7ED'0 5 –g 3
PERMIT N91 2. 6
*20.00«0-