1983, 06-01 Permit App 83A-4716 MH1
PERMIT NUMBER
rat rrLI' I IVIv/ rtKM1 1
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
4.
5.
6.
STREET ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1 } �° A O
LOT BLOC SUBDI 'IS ON
2. j PIN MOrIL� c
OWNER
3�J��AN1M
MAILING ADDREbb0
CONTR CTO
ADDRESS
DESIGNER
ADDRESS
017
LICENSE EXPIRES
PHONE
HONE HONE
ZIP
PARCEL NO.
07 5 - 4--z-1
LEGAL DESCRIPTION:
Actual Set Backs in Feet to: 0.74.1
North }South CC
Size of Parcel
East
West
Zone CI. ification
Sprinklered
❑Yea ❑No ❑Req'd.
Residentia1.12
Commercial ❑
CHANGE OF USE FROM
PHONE
ZIP
TO
TYPE EW 0 ALT. 0 AD'N. ❑ RP ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH. .H. ElPOOL
8. �G 1 f'}°1 '
VALUATION SOOUFCE GAS
9 1000 UTILITIES
NewConst. Valuation
Remode ed Valuation
Main Floor Upper Floors Garage/Storage
Cover Deck
Total Bldg. Floor Area
Greenhouse
Uncv. Deck
Fin. Basement
No. Baths
No. Floors
Unfin. Basement
No. Fln. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑ No❑
Number
DESC IBE WORK
i
C7
ELECTRIC
WATER
PUBLIC
PRIVATE Cl
SEWAGE
SEPTIC.
SEWER ❑
Shorelines/Flood Hazard
Yee Not Applic. ❑
Ownership
Public ❑ Private.
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions s 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 INSPECTION
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Pre
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
Nc?
l/ 2
APPLICATION
DATE
SPECIAL CONDITIONS: (SEE l3VERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
6�O—r
Plans Required 0
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 0
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEWIDQ 1 8 3 PERM IT41 .16 z * 5 p, 0 0 AL