1983, 01-28 Permit 83A-669 Residence, GaragePLAN.NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMEWT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET
1,2. 7 17isi ,,JOC9 r.1/\/&
2. LOT BLO SUB�D�IS�Ovr—'�✓ f
OWN R
3. M
. ears
MAILING A�pIS�j M mc.
4. CO}i�)
ADDRESS
P ON PHONE
7,2-0 &)
PHONE
LICENSE EXPIRES
ZIP
PARCEL NO. ,2 50201
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North SC) (South
DESIGNER
5.
ADDRESS
PHONE
ZIP
Size ofrarG i I "-'
[East I 0 I West 2
Zon,e VGlassifica to Residential
41iIJV Commercial ❑
Type TittLiupan pr nklered
— ❑Yes ❑No ❑Raga.
Neyri nst. nation Remode ed Valuation Total Bldg. Floor Area
6.
CHANGE OF USESEFROM
TYPE ,r� EW
7. OF P16LD.
WORK
TO
Main fippgr•Figorb
17
Un v. Qeck
Cover Deck
Garagg{SjI 4
Greenhouse
Fin. Basement
Unfin. Basement
❑ ALT. ❑ AD' N. ❑ RPL. D MVE.
D PLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Bat hsv
No. Floors
No. Fin. Rooms
I0
No. D iellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑/
Received Yes❑ Not'f
8. DESCgLBK �6
VALUATIONA1 SOURCE GAS ff( ELE`CCTTRIC PUBLICRQ'
9 UTILITIES PRIVATE ❑
SEWAGE/
SEPTIC
SEWER ❑
Shorelines/Flood Hazard
Yes NotApplic. 0
Ownership
Public 0 Private 0
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 REV) SE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF APPLICATION of OWNER OR AGENT �(Z�xe T ,��Q"1.c DATE U •
SPECIAL APPROVALS SPI5C AL CONDItIONS: (SEE REVERSE SIDE FOR NOTICE)
LI , (� .3 1 T C27c
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
11i K'Ji
1/2X-
y0
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Number
Plans Requ redL(/
Received t�
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ r.;;01
02* *531,00
*531.0n
r� * 0, 0 0
6682
01 --27-83
2 6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0.1'727-83
DATE ISSUED
66.92 *'5,31.00at
PERMIT NO. TOTAL