1983, 06-09 Permit 83A-5088 MHPLAN NUMBER
APPLICATION/PERMIT
. SPOKANE COUNTY — DEPATITIVIF:NT 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.
LOT
2.
BLOCK
SUBDIVISION
OWNER
3 COL01( . MC1<INt-,1 -/
MAILING ADDRESS
4.
5.
CONTRACTOR
ADDRESS
DESIGNER
ADDRESS
PHONE
LICENSE EXPIRES
PHONE
G:4-1S3o
ZIP
cp;
PHONE
ZIP
PARCEL NO.
O'501
LEGAL DESCRIPTION: E-1/-2. --v 5 '\)Gg.A.
AGtual ,et Backs in Feet to:
North ;%, 'South
Size of Parcel
4-. P, t
Type Const.
..rN
Occupancy
[East
lWest
Zone Classification
AL2\
Residential V-`
Commercial 0
Sprinklered
❑Yes ❑No ❑Req'd.
PHONE
ZIP
ew Const. Valuation
l ¢, oar}
Main Floor
Remode ed Valuation
Upper Floors
Garage/Storage
Total Bldg. Floor Area
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fln. Basement
Unfin. Basement
TYPE E'I NEW
7. OF
WORK D BLD.
D ALT. D AD' N.
❑ PLMB. ❑ MECH.
❑ RPL.
IN M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required
Received
Yes ❑ NoC
Yes❑ Non
Number
8.
9.
DESCRIBE WORK
sik.X.%cam Wtt
VALUATION
SOURCE
UTILITIES
W\, iA •
GAS
ELECTRIC
(4 c10 )
WATE
PUBLIC
PRIVATE 0
SEWAGE
SEPTIC
SEWER 0
Shorelines/Flood Hazard
Yes❑ Not Applic. 0
Ownership �/
Public 0 Private tie
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 REVERE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF ` APPLICATI�!N
OWNER OR AGENT U�ut /t/ �7/ DATE 4K �• /97A?
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
DTh84 /
Utilities
SEPA
Plans
Exam.
Building
Tech.
c11783
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required 0
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home SO r (oc)
Other (Specify)
TOTAL $t71
PERMIT NUMBER
*000
A sk0,00 3
508.7
06-09-83
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE I&fS6ED 0 9 8 3
PERMIT 400 8. 8 * 5 O. O. OTN1
/4 0
.b7-0 AWL-.
111
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