1983, 03-16 Permit 83A-1939 Move ResidencePLAN 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
ST EETADDRESS
1. L 3I0
LO BLQCK SUB IVISION
2. 2 I --To1ccl,
OWNER A�, II ,�A �
3 Kot iM k A . Pf 91\1
MAILING ADDRESS
1C1-)
4.
5.
ADDRESS
DESIGNER
ADDRESS
)10-
SHO(N�E
,'- -' 7.
LICENSE EXPIRES
PHONE
HONE
ZIP
PARCEL NO.
( ?,t4I ._
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North • ' 7 I South [East
ne Classification
Sprinklered
❑Yes ❑No ❑Req'd.
Size of Parcel
Type •net.
Occupancy
West3l?
Residential [S
Commercial 0
CHANGE OF USE FROM
TO
PHONE
ZIP
New Const. Valuation
Main Floor
Cover Deck
Upper F oors
Uncv. Deck
Remodeled Valuation
CI
Garage/Storage
Fin. Basement
Total Bldg. Floor Area
Greenhouse
Unf . Bas ment
TYPEEW ❑ ALT. ❑ AD'N. ❑ RPL. ® MVE.
7 WORK '=' BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL ❑OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
CertifI. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑ No❑
Number
8.
VALUATION
9.
DESCRIBE WORK
-el g'kCJIC)
SOURCE GAS
F
UTILITIES
--� leWeApOili
)EWAGAV
ELECT- C PUBLIC WATE l� SEPTC
PRIVATE ❑ SEWER ❑
Shorelines/Flood Hazard
Yes Not Apollo. 0
Ownership
Public 0 Private
I hereby certify that I have read and examined this appl cation 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 REV SE SIDE FOR REQUJRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT /'�
l- 07U
APPLICATION
g CJZ
DATE c. ..
SPECIAL APPROVALS
PRELIM. )AL DATE
Env. Health
Planning
afilik%
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
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 ❑
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $60
PERMIT NUMBER
9k-1p,
02* *6'800
19382
03-16-83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
•
DATEISSUEt:)- 6 _ 8 3 PERMIT1N&.3 9 z
*68,00
0
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