1983, 04-11 Permit 83A-2818 ResidencePLAN NUMBER
APPLICATIONJPERMIT
SPOKANE COUNTY — DEPA-RTMMNT 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. 13 q 7.3 AP'ud •/
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. 4I111'1A( A 4v C'.3N
MAILING ADDRESS
CONTRACTOR
4. �Arn.E
v�NLN vif[z
ADDRESS
GiarvtE
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
PHONE
LICENSE EXPIRES
PHONE
08--0-1c17
ZIP
CIOV) .off
PHONE
ZIP
PHONE
ZIP
TO
TYPE 6JEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF
WORK NriBLD. ❑ PLMB. ElMECH. ❑ M.H. ElPOOL
❑ OTHER
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South 30
Size of Parcel
x 145-
own "1-1 ►�.vn: Ch F
East
West 'ZCsI
Zone Classification
Residential
Commercial ❑
eZ"st. I Occupancy
.JLN
ew Const. Valuation
1
Main Floor
9(2
Spr'nklered
❑Yes ❑No ❑Req'd.
Remode ed Valuation
Upper Floors
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Garage/Storage
Total Bldg. Floor Area
(7_
Uncv%k
No. Floors
Required
Fin. Basement
Greenhouse
No. Fin. Rooms
Unfin. Basement
6,
No. Dwellings
Yes❑ Non(' Number
Received Yes❑ Nol
DESCRIBE WORK
8. c.,NGt YArrtI.t_s4 t
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATE
PUBLIC
PRIVATE ❑
SEWAGE,"
SEPTIC IV
SEWER ❑
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Ownership
Public ❑ 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 I al law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REOUIRED IE ONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPR
PRELIM
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
APPLICATION
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
plans S [?.. PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Building
Tech.
Plans Required
Received
FEES COLLECTED
Building ip Z €✓ •c
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
4B31,N%-2E3%8
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE9SSUED1 ` _ 8 3
PERMITO. z 8. 0
O TOTAL