1983, 08-05 Permit App: 83A-7401PLAN NUMBER
n
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTI4g0OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
4111
STREET ADDRESS
1. S
LOT
2.12)
BLOCK
G
SUBDIVISION i 1)1.6 01/44OMI
3.
4. ADDRESS
01/IN, �• cf1&e7
MAILING ADD SS
.27
cr r-1.6164,
1 ��PHONE
LICENSE EXPIRES
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6. ,
P7;5' '00)(6
PHONE
ZIP
TO
TYPE W ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL ❑OTHER
PARCEL NO.
z.9szt-I — 0313
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North (South
Size I C5
o
Oce, q'ricy
T
YperNi
New CCoon�st.Valuation
Main Floor
East 0312
e
West {/
Residential H'
Commercial 0
if ion
Spr'nklered
❑Yes ❑No ❑Req'd.
Remode ed Valuation
Upper Floors
GaragelStor age
Total Bldg. Floor Area
DE RIBE W RK
8. 41. 1` GGA d,
VALUATION SOURCE GKS ELECTRIC PUBLIC
WATER/9• UTILITIES PRIVATE 0
SEWAGE
SEPTIC 0
SEWER ❑
Cover, kco
No. (Baths
Uncv. Deck
No. Floors
Certifi. of Exempt.
or Variance
Fin. Basement
Greenhouse
No. Fin. Rooms
Required Yes ❑ No❑
Received Yes No El
Shorelines/Flood Hazard
Yes❑ NotAoolic.❑
Ownership
Public 0 Private
I hereby certify that I have read and examined this application and have read the 'NOTICE" provisions included
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 t provisions o any er state or local law regulating construction or the performance
of construction. SEE REV / E SIDE I • ' E D I, ' CTIONS
SIGNATURE OF frir
APPLICATIO
OWNER OR AGENT 4 DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Pans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
60.1--r ciA ►J6
cc-1217-AL.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Requ'red ❑
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Horne
Other (Specify)
TOTAL $ 1 "
PERMIT NUMBER
I - 74-01
02* *4700
*47006
A *000 8
740.08
08-05-83
2 6479,
FILE COPY
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08 05.-83 740,15 *4700a.
oJ
DATE ISSUED PERMIT NO. TOTAL