HomeMy WebLinkAbout1983, 08-10 Permit App 83A-7593PLAN NUMBER
G
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. S. 4-21—4:7-l'h— t-\o�t3s
LOT BLOCK SUBDIVISION
2. 4 1 ( c> .p D
OWNER
3. Z.cy zjz LCU > 11 C
MAILING ADDRESS
I(a A
CONTRACTOR
A h'1.tr
4.
ADDRESS
PHONE
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
Qat
PHONE
ZIP
PHONE
ZIP
TO
OF
TYPE ❑ NEW 0 ALT. 0 AD'N. ❑ RPL. ❑ MVE. J
7 WORK 0 BLD. 0 PLMB. ElMECH. 0 M.H. 0 POOL LrS OTHER
DESCRIBE WORK
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
.0AR(.":71_. NO.
LEGAL DESCRIPTION:
Actual
North
Set Backs in Feet to:
South
Size of Parcel
Type Const.
Occupancy
New Const. Valuation
Main Floor
East
West
Zone Classification
Residential ❑
Commercial ❑
Spr'nklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Upper Floors
Cover Deck
No. Baths
Garage/Storage
Uncv. Deck
No. Floors
Certifi. of Exempt.
or Variance
Total Bldg. FioorArea
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ No❑
Received Yes No❑
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 REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGEN E-�.-E CG• �1✓
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATI
DATE L�c/; / Jd
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Requ red 0
Received 0
FEES COLLECTED
Building (O..E,e)
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ (a.p
PERMIT NUMBER
• '1ST
02* *10.00
*10,008
R *0.00
759.22
08-10-83
2 6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQS5UE4 O 8 3`
o
PERMII7No.9,•zzJ
*1 0, 0 0 IdTAL
rnrr_nvv