1983, 11-03 Permit 83B-1063 MHHrrLIt'A 1 ION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE WAP IINGTON 99260 / (509) 456-3675
STREET ADDRESS
1.
L
2.
OWNER
BLOCK
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
l/a2D
PARCEL NO.
MAILING A RESS
COATFIA TOR
ESS
SUB ION
1
thhilieryiezi
PHO 26 5 PH92 HI
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
TO
ZIP
PHONE
ZIP
PHONE
ZIP
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North
ny
West
Size of Parcel Zone Classification
'South
Residential ❑
Commercial ❑
Type ,/Y
Occu ncy
3
NewConst. Valuation
Sprinklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage
Cover Deck
Uncv. Deck
Greenhouse
Fin. Basement
Unfin. Basement
TYPE ffilIEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB_ ❑ MECH. Pr.O.H. ❑ POOL
8.
9.
DESCRIBE WOR
VALUATION
�J% 04X10)
SOURCE GAS ELECTRIC WATER
OF PUBLIC ❑
UTILITIES PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifl. of Exempt.
or Variance
Shorelines/Flood Hazard
Yes❑ NotApplic. ❑
Ownership
Public ❑ Private fe
Required Yes No❑
Received Yes❑ No❑
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 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 INSPECTIONS
OWNER OR AGENT
SIGNATURE OF .1"rgi, • v APPLICATION
� --- /D � � rh- �3
SPECIAL APPROV LS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
/ '
SPECIAL CONDI N . SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Number
Plans Required ❑
Received C
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
50.
PERMIT NUMBER
e38 /063
0.7*- ,*50.00
*50006
A *0.00 8
1062-�
1.0.-28-83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEIS$(JED' 0 0
PERMITI4d. 6 3 z * 5 0. 0 O P0t74L