1983, 02-08 Permit 83A-929 MHPLAN NUMBER
01
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
STREET ADDRESS
1. C. • t\O 2.0 N\ p,,u�.�F-tE _c
LOT
BLOCK
SUBDIVISION
OWNER
3. cN4 rvE E.Aic'fJ
MAILING ADDRESS
. i161D
CONTRACTOR
4. ` +..0.e.
ADDRESS
DESIGNER
5.
PHONE
74c-
PHONE
ZIP
4,71oc
PARCEL NO.
OCt
LEGAL_ DES&FIIPTION:
Actual Set Backs in Feet to: e K t cz I N C!
North {South {East
LICENSE EXPIRES
PHONE
PHONE
Size of Parcel
Occupancy
Const. Valuation
West
Zone Classification
Z 'r1\
Sprinklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6. ZIEW
TYPE
7. OF ❑ BLD.
WORK
TO
❑ ALT. 0 AD'N. 0 RPL. 0 MVE.
❑ PLMB. 0 MECH. VM.H. ❑ POOL
0 OTHER
Cover Deck
No. Baths
Uncv. Deck
No. Floors
Fin. Basement
No. Fin. Rooms
Certifi. of Exempt.
or Variance
Required
Received
Yes Nod/
Yes ❑ No Vi
Unfin. Basement
No. Dwellings
Number
DESCRIBE WORK
8•�.L7�, u c E
90 VALUATION
cocs
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
V"tt Q tom.
SOURCE GAS
F
UTILITIES
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
ELECTRIC
4 C6,CDJ
ATER
PUBLIC ❑
PRIVATE ❑
SEWAG/
SEPTIC
SEWER ❑
Shorelines! Flood Hazard
Yes Not Applic. ❑
Ownership
Public ❑ Private V
DATECATit = / -11 t/f N • 7
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Reeidentlal [if
Commercial ❑
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular! `�j�n �y�
MFG. Home' LLB' .00
Other (Specify)
TOTAL $ 0-0
PERMIT NUMBER
- Ct
fa
x LIJ0
*100.0
O'
*9
92.8
-08-82
6,479,
0`7* *10000
* 1 00,006
A *0,00
929
02-08-82
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATETSSUEDO 8 8 2
PERMIT NQ. 3, 0 z *1 0 0.0 0 pptAL .