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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 .11 Z. L,QT� BLOC SUB IVl�ld N� wf (�f(� I ti - M 013 tom( 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