1983, 09-14 Permit 83A-9025 Residence, GaragePLAN 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
STREET ADDRESS
1. 1 C/C4a-1 �= r t T' DA_
LOT
2. / 2--
3.
4.
BLOCK
v
SUBDIVISION
<f_L‘oG /s ..110,,r%
OWNER EU- st,4Sjoc /I.)
MAIL( GADDR
Dd x / yot f
CONTR TO
ADDRESS
v
PHONE
7,4V6PI t
LICENSE EXPIRES
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
PHONE
21
PHONE
ZIP
PHONE
ZIP
TO
TYPE icy.Ew ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7 OF
WORK r1 BLD. 0 PLMB. 0 MECH. 0 M.H. ❑ POOL ❑ OTHER
8 DgC We bs 6 VALUATION SOURCE AS
9 UTIOF
LITIES
ELECTRIC
WATER
PUBLIC ✓
PRIVATE ❑
SEWAG
SEPTIC
SEWER ❑
PARCEL NO. ,j _f + _ ( (p
LEGAL DESCRIPTION:-I/��
Actual Set Backs in Feet to:
North (South East �1 l West �7�j,
�
o assifica i n Residential / Commercial El
Size of Parcel
--52--C)}( 117 C
Type 'cctlar
NewfCpryt. V u do
Spr'nklered
❑Yes DNo ❑Req'd.
Remodeled Valuation
Upper Floors
Garage prage
Total Bldg. Floor Area
Greenhouse
Cover Deck
Uncv. Deck
2-0
No. Baths
No. Floors
Fin Basement 100
No. Fin. Rooms
Certifi. of Exempt.
or Variance
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Ownership
Public ❑ Privateer
Unfln. Basement
No. Dwellings
Required Yes❑ No❑ Number
Received Yes No❑ /
Plans Required/
Received
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 SI,BEFVR REQUIRED INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT •l� e---er- DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
l'e t$'6S/
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
34,
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
834 602s
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQS2UEc1 4 - 8 5
PERMITMA. 2. 5 z * 5 3 3, 0 0 ROOITAL
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