1983, 02-24 Permit 83A-1287 MHrt.hry oftIV1°mm
PERMIT NUMBER
7A' «7
RrrLIII.A I IVIV/ YtKlVl1 I
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
1.
2.
STREET ADDRESS
LOT - IBI OC 2 HANUBDIVISION -ri 6,L�
L2-
378ES1.i�
4.
ADDRESS
MAI NG ADDRESS
• 1—v c
CONTRACT
li
f N crr
PHONE
328-61�Z
PHONE
LICENSE EXPIRES
-2og
HONE
ZIP
PARCEL NO.
o, 54-4- - O+2
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North
Size of Parcel
Type Const.
South
Occupancy
rxrik6
West
Zone Ciasslf . tion
Sprinklered
❑Yes ❑No ❑Req'd.
Residential'
Commercial 0
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
CHANGE OF USE FROM
6.
ZIP
TO
TYPE Ilr EW ❑ ALT. 0 AD'N. 0 RPL. ❑ MVE.
7 OF WORK 0 BLD. 0 PLMB. CIMECH. /M.H. ❑ POOL GI OTHER
Main Floor Upper Floors Garage/Storage
Cover Deck
No. Baths
Uncv. Deck Fin. Basement
No. Floors No. Fin. Rooms
Greenhouse
Unfin. Basement
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes ❑ No❑
Number
DESCRIBE WORK
8.
VALUATION
9. "6Ia O
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 cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REV RSE SIDE FOR REQUIRED INSPECTIONS
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
SOURCE
F
UTILLIITIES
6 (l 4" c Coo
GAS ELECTRIC
WATER
PUBLICATE
PRIVATE❑
SEWAGE
SEPTIC P1
SEWER 0
Ownership
Public 0 Private
SIGNATURE OF �% APPLICATION. g
OWNER OR AGENT -0"�' �j DATE al y' 0
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
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
5 o.
TOTAL $
07* *50,00
12a62926atiq83
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
02-24-83 128.7i5 *5Q00a�
DATE ISSUED PERMIT NO. TOTAL