1983, 08-23 Permit 83A-8043 InsertPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1 East 8002 Indiana
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
3 James Pingle
4.
OWNER
MAILING ADDRESS
East 8002 Indiana
CONTRACTOR
ame
ADDRESS
PHONE
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
99206
PHONE
ZIP
PHONE
ZIP
TO
TYPE NEW ❑ ALT. ❑ AD'N. 0 RPL. 0 MVE.
7 OF WORK ❑ BLD. ❑ PLMB. X(MECH. ❑ M.H. 0 POOL ❑OTHER
DESCRIBE WORK
8. Blaze -King Insert
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South East West
Size of Parcel
Type Const.
New Const. Valuation
Main Floor
Cover Deck
No. Baths
Zone Classification
Residential 0
Commercial ❑
Spr nklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Total Bldg. Floor Area
No. Floors
CertifI.of Exempt.
or Variance
Greenhouse
No. Fin. Rooms
Required Yes❑ Non
Received Yes❑ No❑
Shorelines/Flood Hazard
Yes❑ Not Applic. 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 FOIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT / U�
APPLICATION /__/s_c/�
DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDIT 6NS: (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
Plans Requ red ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
20.00
Other (Specify)
20.00
TOTAL $
04* *20.00
*2000'6
A *0,00 3
804.2�
08-23-83
-2 6479.
a
W
- J
L L
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.2 8
DATETSSUED U PERMIT NO. I� z * 2 0. 0
0 O0 AL