1983, 02-24 Permit 83A-1274 MHPNUMBER
I:LAN
%
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. STRE FADDI l S 1AfI7
2.SABLOCK SUI L10 1 L
MIlLI ArREt+ i27 , ",�
CONTRACTOR
V
4' ADDRESS
PHONE
o
PARCEL NO
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North (South
East
IWest
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Clasgiflc#tlon
Cosidential ❑ Commercial
ZIP
Type Conf{t. I
Occupancy2
Spr'nklered
❑Yea ❑No ❑Req'd.
DESIGNER
5' ADDRESS
PHONE
NewConst. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TYPE IIEW
7. OF
WORK 0 BLD.
TO
❑ ALT. 0 AD' N. ❑ RPI. ❑ MVE.
0 PLMB. 0 MECH.
❑ POOL ❑ OTHER
Cover Deck
No. Baths
Uncv. Deck
No. Floors
Fin. Basement
No. Fin. Rooms
Unfin. Basement
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Teen Non
Number
8. DEr riA 2 6 (I X.7'0
VPUATION GAS ELECTRIC
9. ittO
SOURCE
UTILLIITIES
WATER
PUBLIC rir-
PRIVATE ❑
SEWAGE
SEPTIC
SEWER
Shorelines/Flood Hazard
Yes Not Applic. ❑
Ownership
Public 0 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
APPLICATIO
DATE 3 1 7e3
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PEMIT UMBER
U 7 *
12732
02-24-83
6,479.
*50.00
FILE COPY
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
02-24-83
DATE ISSUED
127,4z *50.0u H
PERM IT NO. TOTAL