1983, 02-02 Permit 83A-783 MHSTREEleDDRl
O T `I'„G' L'frcf,\ isoj
MAILING ADD E coNTRIp
I 1.7 ri5i._hr;)
T
4. ADDRESS
DESIGNER
5.
ADDRESS
LICENSE EXPIRES
6.
CHANGE OF USE FROM
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
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ONE _„ _ PHONE
7-72...oc„
PHONE
ZIP
PHONE
ZIP
TO
%. TYPE .....ErNEW 0 ALT. 0 AD'N. ElRPL. 0 MVE.
OF
WORK
❑ BLD. ❑ PLMB. 0 MECH. Pf M.H. 0 POOL ❑ OTHER
DSCRI BE WORK
VALUATION SOURCE
9. OF
UTILITIES
GAS
5
ELECTRIC
PAR!'EL NC,,
o754-4-- Q+2 t
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South
Size of Parcel
New Const. Valuation
East
West
Zone Classification
Residential ❑
Commercial 0
Spr nklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unf In. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC D
SEWER 0
Shorelines/Flood Hazard
Yes Not Applic. 0
Ownership
Public 0 Private 0
Required Yes No
Received Yes Nor]
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 REVERS SIDE FOR REQUI D INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT //. t .cam DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL C NDITTONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Number
Plans Required ❑
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 5
PERMIT NUMBER
u7* *5000
*50,006
A * '': 0 0 a
7a22
02-02-R3
2 6.479.
a.
tJ
W
J
LL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
78.3Z *50,00ab
gEZ-02-83
DATE ISS PERMIT NO. TOTAL