1983, 03-01 Permit 83A-1391 MHFLAN NUMI3tH
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. II7:,2 M -6
OT
2. 10 BL K S DIV SI N I MOi;I 1 116ONE
3. C � j 6„.6,r.' Z-�I PHONE
MAILING ATITS
CONT C7T
t
4.�
ADDRESS
LICENSE EXPIRES
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to: 1,471
/ 1 141
North (South East
Size of Parcel
West
Zone Clasgif illtion
Residential
Commercial ❑
ZIP
Type` vQqn
Spr nklered
❑Yes ❑No ❑ Reg 'd.
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
PHONE
ZIP
TO
TYPE 211sIEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7 OF WORK 0 BLD. 0 PLMB. 0 MECH. B M.H. ❑ POOL ❑ OTHER
DESCRIBE WORK
• of ��
VALUATION
9.
GAS
1L,c5v
ELECTRIC
PUB IEC�
PRIVATE ❑
SEWAGE
SEPTIC
SEWER ❑
New Const. Valuation
Remode ed Valuation
Main Floor
Upper Floors
Garage/Storage
Total Bldg. Floor Area
Greenhouse
Cover Deck
No. Baths
Certlfi. of Exempt.
or Variance
Uncv. Deck
No. Floors
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Ownership
Public ❑ Private
Fin. Basement
Unfin. Basement
No. Fin. Rooms
No. Dwellings
Required Yes❑ No❑
Received Yes Non
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 SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT DATE APPLICATION
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Number
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
50
Other (Specify)
TOTAL $
PERMIT UMBER
9/Yt -1-)471
07* *50.00
139.02
03-01-83
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED'-01— 8
PERMIT1J.9. 15 * 5 0. 0 0 $C{itAL