1983, 05-11 Permit 83A-3940 MHPLAN NUMtitN
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
1.
STREET ADDRESS
E.. =*ci.(o
LOT
2. 01,
OWNER
3. 1S,fm.
4' ADDRESS
BLOCK
MAILING ADDRESS
SUBDIVISION
PHONE PHONE
).jf:.LA.b-14VLC�EYe— Gi 3r $
C 7Cq r). -t.LL ram.
CONTRACTOR
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE ill NEW
7. OF
WORK ❑ BLD.
LICENSE EXPIRES
PHONE
PHONE
ZIP
TO
❑ ALT. ❑ AD'N. 0 RPL. 0 MVE.
—/ CI OTHER
❑ PLMB. 0 MECH. lid'M.H. 0 POOL
PARCEL NO.
Bet `514 -
LEGAL DESCRIPTION:
Actual Set Backs in Feet to: Ex
North [South [East
Size of Parcel
Type Cont.
Newtbnt. Valuation
Main Floor
IWest
Zone Classification
Residential I
Commercial 0
Spr nklered
❑Yee ❑No ❑Req'd.
Remode ed Valuation
Upper Floors
Garage/Storage
Total Bldg. Floor Area
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
No. Floors
Fin. Basement
Greenhouse
Unf in. Basement
No. Fin. Rooms
No. Dwellings
Required Yes❑ No
Received Yes❑ Noll
Number
DESCRIBE WORK
8. S. k /J 4t LC LL) k C-D'
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
(34-x-70
WATER
PUBLICWe
PRIVATE 0
SEWAGE/
SEPTIC
SEWER 0
Shorelines/Flood Hazard Plans Required ❑
Yes Not Applic. ❑
Ownership /
Public ❑ Private MT.'
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 ) " i� APPLICATI
OWNER OR AGENT'\] �Y1 ti- 17^�.I. i4�`--( DATE
SPECIAL APPROVALS SPECIAL CONbIITIdNS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
94-*3
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/ �y�>
MFG. Home 60k
Other (Specify)
TOTAL $
PERMIT NUMBER
S)341%-
.0Q
0. Do
Q . 00 C-Ci •
a-
a-
O
tJ
J
U-
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQSUED1 1 - 8 3
PERMIT/J.4 0 z * 5 O. 0 0 1*OIrAL