1983, 03-21 Permit 83A-2073 MHPLAN NUMBER
(7)
APPLICATIOJV/PERMIT
SPOKANE COUNTY — DEPAI T OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1. sTRErTIADD ESD 6 ` � Ii✓
SUBpJVI$10� 0511
s. 1 -�a_ik L. J
M/jILING I ESS 2C7 6,2)
BLOCK
CON
ADDRESS
4307
LICENSE EXPIRES
e
PHONE
PHONE
ZIP
PAF;rFL NO. 514
O 1
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:15-1 I
North (South 1East
DESIGNER
5' ADDRESS
•
CHANGE OF USE FROM
PHONE
ZIP
TO
TYPE f NEW 0 ALT. 0 AD' N. 0 RpL. ❑ MVE.
7. OF ❑ BLD. 0 PLMB. 0 MECH. M.H. 0 POOL 0 OTHER
WORK
Size of Parcel
Type Viz).
New Corot. Valuation
CCX)
Main Floor
Occupancy
West
one Classification
f, igatlon
Residential
Commercial ❑
Spr nklered
DYes ❑No ❑Req'd.
Remode ed Valuation
Total Bldg. Floor Area
Upper Floors
Garage! Storage
Cover Deck
No. Baths
Certlfi. of Exempt.
or Variance
Uncv. Deck
Fin. Basement
Greenhouse
No. Floors
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
F
UTILITIES
GAS
WATER
ELECTRIC PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC 0
SEWER 0
No. Fln. Rooms
Required Vasil No❑
Received Yes ID Non
Shorelines/Flood Hazard
Yes Not Applic. ❑
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 REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tern
APPLICATION
DATE T7 I ?:3
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT UMBER
2 7
07* *50.00
*50.006
A *0.00 0
207.2g
03-21-83
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQS UEl; 1 - 8 3
PERM1 O. " 3 z * O, O O *OCTAL