1983, 08-24 Permit 83A-8182 Special InspectionPLAN 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
STREET ADDRESS
N•4U'3 tVOR`b VTV
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. 1ktctL(V1L
MAILING ADDRESS
N ? 'AiV t LLAfa lV
CONTRACTOR
4. ADDRESS
PHONE
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
424- C1tUB
ZIP
CA
PHONE
ZIP
PHONE
ZIP
TO
TYPE ❑ NEW 0 ALT. 0 AD'N. 0 RPL. 0 MVE.
7. OF ❑ BLD. 0 PLMB. ❑ MECH. ❑ M.H. 0 POOL
WORK
OTHER
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs In Feet to:
North South
Size of Parcel
Type Const.
Occupancy
New Const. Valuation
Main Floor
East
West
Zone Classification
Residential 0
Commercial 0
Spr nklered
DYes ❑No OReq'd.
Remodeled Valuation
Upper Floors Garage/Storage
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Total Bldg. Floor Area
Uncv. Deck
No. Floors
Fin. Basement
Greenhouse
No. Fin. Rooms
Required Yesf No❑
Received Yes Non
DE CRIBE WORK
CC.yr\L. tYUGF�6C-�cc,N
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Shorelines/Flood Hazard
Yes0 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 ordlnances governing thls 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
IGNATURE OF APPLICATION
OWNER OR AGENT DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
Siczk
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfln. Basement
No. Dwellings
Number
Plans Required 0
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify) C •-c.
TOTAL $ b°
PERMIT NUMBER
tE?s
02* *8.00
*8.00.5
A *0.00
818.12
08-24-83
2 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEYSSUED2 4 .8 3
PERMIT NO. 8. 2 z * 8• O O tL TOTAL