1983, 01-27 Permit 83A-665 MH4)
1.
HrrLII,M 1 IVIV/h'LHMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
STREET ADDRESS
LOT
2. —2.0 Ogg
3 >�v ,Ef
M5LILING 9ADD/ �
T C • cT Y
4.
ADDRESS
DESIGNER
55.
ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
BLOCK SUBDIVISION
ri is
ESS
&I�
PARCEL NO.
LICENSE EXPIRES
CHANGE OF USE FROM
6.
TO
PHONE
3-07
PHONE
ZIP
PHONE
ZIP
°9 5+41- - oq- 21
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North [South
IWest
Size of Parcel l ZoneCiarirtion
TypeeCop1V
V
Occupancy
Remodeled Valuation
New Const. Valuation
Residentialr
Commercial ❑
Sprinklered
❑Yes ❑No ❑Req'd.
Main Floor Upper Floors
Cover Deck Uncv. Deck
Garage/Storage
Fin. Basement
Total Bldg. Floor Area
Greenhouse
Unfin. Basement
TYPEW ❑ ALT. ❑ AD' N. ❑ RPL. 0 MVE.
7. OF
WORK ❑ BLD. ❑ PLMB. ❑ MECH. 12"M.H. ❑ POOL
DESC BE WORK
8. Ap �� �� l4X -7�)
VALU ION
• 101 000
SOURCE
F
UTILITIES
GAS
ELECTRIC
0 OTHER
WATER
PUBLIC
PRIVAT ❑
SEWAG
SEPTIC
SEWER ❑
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑
No ❑
Number
Shorelines/Flood Hazard
Plans Required ❑
Yes Not Apollo. ❑ Received ❑
Ownership
Public ❑ Private Of
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
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 hether specified herein or not. The granting of a permit does not presume to give au-
thority to violate or canc the provisions of any other state or local law regulating construction or the performance
of construction. SEE RE ERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
V7 7
A/017241 AP,PL�ICA O
D 07/9�3,
rCIAL CONDITIONS: (SEE REVERSE SIDE FOR OTICE)
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)
G'
TOTAL $
PERMIT NUMBER
07* *5000
6642
01-27-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE 119bED2 7 - 8 3
PERMIT NO: 65
*50.00;t„L