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