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1983, 05-13 Permit 83A-4036 MHPLAN NUMtitM HrrLmom 1 IVni/ rtKIVII I SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 PERMIT NUMBER 83A— o3G APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES STREET ADDRESS 1. E,. 9,zo n1Arlsrl e5 LOT EtLOCK SUBDIVISION 2. PluEclzO MOBILE, HOMEc.-r OWNER 3. t-C/)T11 W l Nr i ELD MAILING ADDRESS E II`(zo MANSFiE CONTRACTOR 4 SM- ADDRESS PHONE Gjz.4-41 LICENSE EXPIRES PHONE ZIP 72- c C> PHONE ZIP PARCE NO. CCf 5 L - 0 421 LEGAL DESCRIPTION: Actual Set Backs in Feet to: North South East West Size of Parcel Type Const. V -N Occupancy R- 3 Zone Classification M+ Residential ❑ Commercial ❑ Sprinklered ❑Yes No ❑Req'd. DESIGNER 5. ADDRESS CHANGE OF USE FROM • PHONE ZIP TO TYPE Q �EW ❑ ALT. 0 AD'N. ❑ RPL. 0 MVE. 7 OF WORK ❑ BLD. ❑ PLMB. CIMECH. CC-W.-H. LCPOOL ❑ OTHER New Const. Valuation '25 Doc -- MFloor aic80 Remode ed Valuation Upper Floors Garage/Storage Total Bldg. Floor Area Greenhouse Cover Deck Uncv. Deck Fin. Basement Unfin. Basement No. Baths No. Floors No. Fin. Rooms No. Dwellings Certifi. of Exempt. or Variance Required Yes No❑ Received Yes❑ No❑ Number DESCRIBE WORK 8. n1 ts8iLE Ho poi E S R S ipENcE ) -j x 7 O w ofk ExtW4 VALUATION 9. SOURCE F UTILLIITIES GAS ELECTRIC WATER PUBLIC ❑ PRIVATE ❑ SEWAGE SEPTIC 0 SEWER ❑ Shorelines/Flood Hazard Plans Required 0 Yes (2 NotAppiic. ❑ Received ❑ Ownership Public ❑ Private 0 I hereby certify that I have read and examined this application 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 REVERSE SI E FOR REO)JIREt INSPECTIONS SIGNATURE OF / / / ` '/ APPLICATION OWNER OR AGEN /tfirt.e, i/✓liX�'-Gc'-k DATE SPECIAL APPROVALS PRELIM. FINAL DATE Env. Health Planning Fire Prevent. Engineer Utilities SEPA Plans Exam. Building Tech. SPECIAI/CONDITIONS: ('SEE REVERSE SIDE FOR NOTICE) PERMIT 1S 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 5t, Other (Specify) TOTAL $ 5v - 07* *50.00 *50.00 *50.006 A *C00 403,52 05-13-83 2 6479. WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. DATE153UED1 5 - 8 3 PERMIT'Nd 3.5 2 * 5 0. 0 01?otAL