1983, 05-04 Permit 83A-2712 MHr s_r-iv r JIv,ucn
Arr-Ill„H I IVIV/rLKMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
2.
3.
STREET ADDRESS
LOT
i
OWNER
TC�rvt
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
BLOCK
• l \G -Lc+ YY1 %Vra a C ►s‘.. a)
SUBDIVISION
PARCEL NO.
dci 544 -o4t -1
PHONE
PHONE
8:5Pa'e•->1
LEGAL DESCRIPTION:
MAILING ADDRESS
E.. ik•Ct�o
N\tar.»>=tEut�
ij}-
ZIP
Q
4.
5.
CONTRACTOR
ADDRESS
ry
DESIGNER
LICENSE EXPIRES
PHONE
ZIP
PHONE
Actual Set Backs in Feet to:x ` itv5
North [South East West
Size of Parcel
ADDRESS
ZIP
Type Const.
Occupancy
72.
NejConst. Valuation
10,c
Main Floor
Zone Classification
N\ F`�
Residential 1/
Commercial 0
Sprinklered
❑Yes ❑No ❑Req'd.
Remode ed Valuation
Total Bldg. Floor Area
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
TYPE /NEW 0 ALT. ❑ AD' N. ❑ RPL. 0 MVE.
7. OF
WORK ❑ BLD. ❑ PLMB. 0 MECH. iM.H. 0 POOL
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
0 OTHER
No. Baths
No. Floors
Certifi. of Exempt.
or Variance
No. Fin. Rooms
Yes❑
No
Required
Received Yes No0
No. Dwellings
Number
DESCRIBE WORK
8. Sarvc;L 1rSt0E
(14A70)
Shorelines/Flood Hazard Plans Required
Yes NotApplic. ❑ Received 0
VALUATION
90ot
SOURCE
UTILLIITI ES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE ❑
SEWAGE
SEPTIC
SEWER 0
Ownership
Public 0 Private
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 pr. ions of any other state or local law regulating construction or the performance
of construction. SEE REVER SI . F • IRS INSPECTIONS
SIGNATURE OF APPLICATION)/ /
OWNER OR AGEN'' .%fi � y, DATE1& 7/gam
SPECIAL APPRO 1' S SPE 1►T>/ ONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
N1
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) ..1C> .des
TOTAL $te'
PERMIT NUMBER
—z-t12
*5000
yr ! 1. 1 2^ * SQ,OO6 r3
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEISSUrbO 7 - 8 3
PERMIT2d. 1 2 Z
*5O.00$ ,L