1982, 11-24 Permit: 82B-1379 Wood InsertMrrL It,A 1 WIN/ F'LKM IT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. S z4zo CA6e2y C
LOT
2.
BLOCK
SUBDIVISION
PARCEL NO.
OWNER
3..Jc\-1 -PA 1u. -t t -a
PHONE
PHONE
�z2$4c�t
LEGAL DESCRIPTION:
MAILING ADDRESS
• �'-%O C -140 2e--1 G. ,
CONTRACTOR
4. S Arra
ADDRESS
13 ir)1.6
LICENSE EXPIRES
5.
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
ZIP
Q�1Zi�
PHONE
ZIP
PHONE
ZIP
TO
TYPE M NEW ❑ ALT. ❑OF/AD' N. 0 RPL. ❑ MVE.
7.WORK ❑ BLD. 0 PLMB. �f MECH. ❑ M.H. 0 POOL 0 OTHER
Actual Set Backs in Feet to:
North !South
Size of Parcel
Type Const.
Occupancy
New Const. Valuation
Main Floor
East
West
Zone Classification
Residential ❑
Commercial ❑
Sprinklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Upper Floors
Cover Deck
Total Bldg. Floor Area
Garage/Storage
Uncv. Deck Fin. Basement
No. Batns
No. Floors
Certifi. of Exempt.
or Variance
Greenhouse
No. Fin. Rooms
Required Yes No❑
Received Yes No❑
Unfin. Basement
No. Dwellings
Number
8. DESCRIBE WORK
�WV .aC2Ni.v4 INSCZ7
VALUATION SOURCEDGAS
9 UTIF
LITIES
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER 0
Shorelines/Flood Hazard
Yes❑ NotApplic. ❑
Ownership
Public ❑ Private 0
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 pro ' ' .s of any other state or local law regulating construction or the performance
of constructl. . SE IDE FO RE �_ IRED INSPECTIONS
SIGNATURE. / /7// A. APPLICATION`///2 y/9,2_
OWNER OR AGEN '► = �. � Z DATE V
SPECIAL AP OVALS rECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELI
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech. 1 ____O
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL
PERMIT NUMBER
8za- (3-1
04* *20.00
*2Q006
A *0.00 8
137.88
11-24-82
2 6479,
FILE COPY
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE lithe 4- 2PERMIT 105 7, 9 Z * 2 a O OTTML