1983, 07-08 Permit 83A-6333 AdditionPLAN NUMtstH
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
LOT BLOCK SUBDIVISION
2. 5
NTH
OWNER
3. `J CC-JE `�AEi�l.urV
MAILING ADDRESS
VJ C,C 121
CONTRACTOR
4. Orkt,)tJ ridLiA.N
ADDRESS
DESIGNER
5.
ADDRESS
IPHONE
PHONE
ZIP
61Ci?
LICENSE EXPIRES PHONE
CHANGE OF USE FROM
TYPE ❑ NEW
7. OF
WORK BLD.
ZIP
PHONE
ZIP
TO
❑ ALT. {2'AD' N. ❑ RPL. ❑ MVE.
❑ OTHER
❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North Z ISouth
Size of Parcel
Const.
N
Occupancy
T '3
1oCDc
[East
West
Zone Ciasjpification
Residential Cd`-
Commercial D
Spr'nklered
❑Yes No ❑Req'd.
- w Const. Valuation
Main Floor
5a)1
Remode ed Valuation
Tote Bldg. Floor Area
Upper Floors
Garage/Storage
Cover Deck
Uncv. Deck
Q EsCRIBE WORK
8. OD.' «.23rQ
VALUATION
9.
SOURCE
UTILLIITIES
GAS
ELECTRIC
WATER
PUBLIC I�
PRIVATE ❑
SEWAGE
SEPTIC r
SEWER ❑
No. Baths
No. Floors
Certifi. of Exempt.
or Variance
G eenhouse
No. Fin. Rooms
Required
Yes El Noe'
Received Yes❑ Noh �
Shorelines/Flood Hazard Plans Requ red Cfi
Yes NotApplic. ❑ Received
Ownership
Public ❑ Private
Unfin. Basement
t
No. Dwellings
Number
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 SjPyE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
APPLICATI4 2 , g
DATE /
SPECIAL APPROVALS
PRELIM.,.F,INAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
3
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building t C.B c
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
C;2* *108.00
*108006
*0.00
633.22
07-C8-83
6G79,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
((jj k R (} 8
DATEYSS�] UED' " 3
PERM r 4i 3' 3 z * 1 0 8' O 0 .AL