1983, 02-18 Permit 82B-1593 MHrLAN NUMIstH
ArrLIUA 1 ION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
STREET ADORE
1.
QgWNER
3.
4.
5.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
•
7 e7-r0 38
BLOCK SUBDIVISION
MAILIh1G OZL7 N
Ij1111 � �
CONTRA TOR
ADDRESS
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
LICENSE EXPIRES
PHONE
ZIP
PHONE
PHONE
ZIP
TO
TYPE avNEW ❑ ALT. 0 AD' N. 0 RPL. 0 MVE.
7 OFWORK 0 BLD. ❑ PLMB. 0 MECH. el/M.H. 0 POOL ❑ OTHER
DES�CIjIBE WORK
8.
V4LUATION
9. IQ 00 C2
1--z),..4& 11--'"X —7 0
SOURCE GAS ELECTRIC / WATER
OF PUBLIC I
UTILITIES PRIVATE ❑
PARCEL NO. O+2-
1
LEGAL DESCRIPTION:
Actual Set Backs In Feet to:
North ISouth
Size of Parcel
New Const. Valuation
[East
IWest
Zone CI =;cation
Remode ed Valuation
Main Floor Upper Floors
Cover Deck Uncv. Deck
Garage/ Storage
Residential
Commercial ❑
Total Bldg. Floor Area
Greenhouse
Fin. Basement
Unfin. Basement
No. Baths No. Floors
No. Fin. Rooms
No. Dwellings
Certlfi. of Exempt.
or Variance
Required
Received
Yes❑ No❑
Yes❑ No❑
Number
SEWAGE
SEPTIC
SEWER ❑
Shorelines/Flood Hazard
Yes Not Applic. ❑
Ownership
Public ❑ Private
I hereby certify that I have read and examined this appl cation 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 canc he prov':. : of any othey/rstate or local law regulating construction or the performance
of construction. SEE R RS tom,: F R REQJiIRINSPECTIONS
SIGNATURE OF
OWNER OR AGENT
APPLICATION /
DATE
SPECIAL APP • ALS
PRELIM. INAL 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
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
50r
TOTAL $
PERMIT NUMBER
�213- 15,3
67* *50.00
*50.006
H * 00
159,22
12-02-82
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE fS9t.tEDO 2 - 8 2
PERMITNI 9.3z *5O,O0;4-AL