1983, 11-22 Permit 83B-1941 MHrL/YIV IYNIVIGCrl
ArrLIS.R I IUIV/s'LKMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
3 ; t:
4.
ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
LOT BLOCK
I 9l-Va ON LIvisi
p rilIONporN1c.21 1,l ti toG'f
OWNER PHONE PHONE
MAILING ADDRESS ZIP
g". 1I2Z.cv illichkrity, sic,.Z,QG
CONTRACTOR L ENSEEXPIRES PHONE
DESIGNER
5.
ADDRESS
ZIP
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North I South
Size of Parcel
9114�
East
04-74
West
Zone Classification
Residenti
Commerc al ❑
Sprinklered
❑Yes ❑No ❑Req'd.
NewConst. Valuation
Remode ed Valuation
Total Bldg. Floor Area
CHANGE OF USE FROM
6.
ZIP
TO
TYPE s NEW ❑ ALT. ❑ AD' N. ❑ R L. ❑ MVE.7. OF ❑OTHER
WORK ❑ BLD. 0 PLMB. ❑ MECH. H. 0 POOL
DESCRI E WORK
O 631
VALUATION
Oov
SOOURC GAS
UTILITIES
ECTRIC v
PUBLICZ
PRIVATE ❑
Main Floor
Upper Floors Garage/Storage
Greenhouse
Unfin. Basement
No. Dwellings
SEWACSEPTI
SEWER ❑
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck Fin. Basement
No. Floors No. Fin. Rooms
Number
Shorelines/Flood Hazard 1 Plans Required ❑
Yes❑ NotApplic. ❑ 1 Received ❑
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 / APPLICATION
OWNER OR AGENT DATE j1'0(.4 -3
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS 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
Other (Specify)
TOTAL $
PERMIT NUMBER
e2315 - 941
07* *5000
194Cz
11-22-83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE IS14UEO 2 — 8 3
PERMITLN0.4 1 5 * 5 O. O O Qq}AL