1983, 01-07 Permit 83A-0140 RemodelPLAN NUMBER
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 ADFS0 6 3 Ifre
2. L 2 Stab .
3.
4.
74_1 r10111 01d
MAI 1G�AD ESS
CONTRACT F
ADDR, E$S�
DESIGNER
5.
ADDRESS
PHONE
LICENSE EXPIRES
CHANGE OF USE FROM
•
PHONE
ZIP
PHONE
ZIP
TO
TYPE 0 NEW ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7.{• OF
WORK .12'6LD. 0 PLMB. 0 MECH. 0 M.H. ❑ POOL
❑ OTHER
PARCEL NO. I p� ^ I
LEGAL DESCRIPTION:
1, 5, g 2 z tacC , �- Lk A' t 6.?(C , 5, i I r
Actual Set Backs in Feet to: 157n� �601
North (South lEast
Size of Parcel
Type
Occ J ncy
New Const. Valuation
IWest
Zone Classification
Residential.
Commercial ❑
Sprinklered
❑Yes ❑No ❑ Red 'd.
Remodeled Valuation
Total Bldg. Floor Area
DESCREADR
VALUATION-,
9.
SOURCE
F
UTILLIITIES
GAS
0 j26A
ELECTRIC
WATER
PUBLIC ❑
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Main Floor
Upper Floors
Cover Deck
No. Baths
Garage/Storage
Uncv. Deck
No. Floors
Certifi. of Exempt.
or Variance
Required
Received
Fin. Basement
Greenhouse
No. Fin. Rooms
Yes ❑ No❑
Yes❑ Nor)
Unfin. Basement
No. Dwellings
Number
Shorelines/Flood Hazard
Yes Not Applic. ❑
Ownership
Public 0 Private 0
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
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
w
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION • �' 3
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
L.t c... &— Z7 - O I met 4 162--I e?/]
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PER MITE NUMBER
02* *54.00
*54,006
A *C00
1392
01-07-83
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEILL
.—EIP 7 -
PERMIT N8. 0 2 * 5 O 0 RVTAL