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1983, 05-25 Permit 83A-4501 MH
r1..rird I'UIVI pc ri APPLICATION/PERMIT SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 1. LOT 2. CO OWNER 3 S• MAILING ADDRESS APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES STREET ADDRESS E l n 2-a MAI3 1IE�L BLOCK SUBDIVISION cP ACID (�� 3 nnELQppr l\kt LC G1- PHONE ONTI1Ck 2n (V{AY1 E.L1 J C T? LICENSE EXPIRES -(A). flatitz as S ADDRESS DESIGNER 5. ADDRESS 6. CHANGE OF USE FROM PHONE Z'-4(as0 ZII� Pt, ( _ L.ol(J PHONE ZIP PHONE ZIP TO PARCEL NO. 1.) &F ©°I 5 `-I 4- 0 4 -1 LEGAL DESCRIPTION: Actual Set Backs in Feet to: North ISouth Size of Parcel Zone Ciassificatio Type Const. VtV New Const. Valuation on 1t.6� Main Floor upancy West Residential ❑ Commercial ❑ Sprinklered ❑Yes ❑No ❑Req'd. Remode ed Valuation Upper Floors Garage/Storage Total Bldg. Floor Area -28(P Greenhouse Cover Deck Uncv. Deck Fin. Basement Unfin. Basement 7. TYPE SEW ❑ ALT. ❑ AD' N. ❑ RR k. ❑ MVE. WORKOF ❑ BLD. ❑ PLMB. 0 MECH. E'M.H. CI POOL 8 DESCRIBE WORK 1( sc,,) VALUATION SOURCEOFGAS ELEC RIC PUBLIC O 9. UTILITIES PRIVATE ❑ ❑ OTHER No. Baths Certifi. olf Exempt. or Variance No. Floors 1 Required Received No. Fin. Rooms Yes 0No� Yea❑ No❑ No. Dwellings Number SEWAGE SEPTIC ❑ SEWER ❑ Shorelines/Flood Hazard Yes ❑ NotApplIc. Ownership Public ❑ Private 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 REVISE SIDE FOR REQUIRED INSPECTIONS SIGNATURE OF I n � � V %r] C _2S- OWNER OR AGENT ! I (, L DATE APPLICATION J (}yi3 SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE) PRELIM. FINAL DATE Env. Health Planning Fire Prevent. Engineer Utilities SEPA Plans Exam. Building Tech. u�- PERMIT IS NONTRANSFERABLE PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED IN 180 DAYS Plans Required ❑ Received D FEES COLLECTED Building Plumbing Mech. Plan Check SEPA Modular/ MFG_ Home Other (Specify) So_ TOTAL $ Se — PERMIT NUMBER A y5DI WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. DATE Ig1365 2 5' - 8 3 450,1 PERMIT NO. z *50,00 aI-- TOTAL O W —J