1983, 05-06 Permit 83A-3752 MH1,1,01,11.1,1111
MrrLI1/4M 1 Ivnu rttiml 1
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER
Seib<
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1 • E_. /6 867
LOT
2.
BLOCK
INJ> ANA Ave
SUBDIVISION
OWNER
3 I-* ERNi`. sT i ��2t-rAG
M ILING ADDRESS • .�7T/Z BROADIWA/y
CON RAC OR
4. SR111 --
ADDRESS
PHONE
37644
LICENSE EXPIRES
PHONE
ZIP
PHONE
ZIP
PARCEL NO.
z 2 Zi"41- — 0105
LEGAL DESCRIPTION: PT oiF 13 13 8t✓c3 A-r SS-c off. S 13
Ti+- 3 ' ° W ' u) A4 S L 5 8r;.6 6' TN f� /6e
08 1 30 " E z5o.1j FT-Iro or✓ cu4SE.cuPV
To NC-7Fri F-1 Tht.S OF 145,37 PT lop- no,T3 FT £ -
Actual Set Backs in Feet to:
North I Tj O' I South East 20 0 f West 360
Size of Parcel Zone Classification
7 1. -s ApPl244 21c.,h,L-ruP.tft
Type Const. Occupancy Sprinklered
❑Yea ❑No ❑Req'd.
Residential L (—
Commercial 0
DESIGNER
5. ADDRESS
6.
CHANGE OF USE FROM
TO
PHONE
ZIP
Nwf Const. Valuation Remode ed Valuation
3i Yoa
Main Floor
Cover Deck
Upper Floors
7.
TYPE -IQEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
OF ❑ BLD.
WORK
❑ PLMB. ❑ MECH. zH. 0 POOL
❑ OTHER
No. Baths
CertifI. of Exempt.
or Variance
Uncv. Deck
78
No. Floors
Garage/Storage
Fin. Basement
Total Bldg. Floor Area
)34-#
Greenhouse
Unfin. Basement
No. Fin. Rooms
6
Required Yes❑ No❑
Received Yes No❑
No. Dwellings
Number
8.
9.
DESCRIBE WORK
if�t ol�a r rnF_ R.F --SiD ck_ 51
ATE
PRIVATE ElPUBLIC ❑
VALUATION
SOURCE
UTILITIES
GAS
ELECTR
SEWAGE
SEPTIC ❑
SEWER ❑
Shorelines/Flood Hazard
Yes NotApplic. ❑
Ownership
Public 0 Private 0
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 REVERS SIDE FOR REQUIRE INSPECTIONS
SIGNATURE OF APPLICATION Fa
OWNER OR AGENT ✓ DATE
�� ! /r
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FIN DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required 0
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular! 00,
MFG. Home-¢/r7�f2.icy
Other (Specify)
Op
TOTAL $ 1121.2_21-X
07* *100.00
375.1
05-06-83
6 479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED 0 6 - 8
37525 *10O.00
PERMIT NO. TOTAL
ry71
0