1980, 01-06 Permit: 80-905 Heat PumpP` aN N1Th$BER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
1.
2.
3
JOB ADDRESS
N
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
SUBDIVISION
OWNER
ADDRESS
CONTRAC
4. ADDR
S([
DESIGNER
5. ADDRESS
P ONE
US) aCYCL
ZIP
PHONE
Z19 9�0
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South [East 'West
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation 1Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
8.
9.
TO
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
DESCRIBE Wo RK
VALUATION
❑ ALT. 11 AD'N. ❑ RPL.
❑ PLMB. &&1 MECH. ❑ M.H.
1
Source
of
Utilities
GAS
❑ MVE.
O POOL
0 OTHER
ELECTRIC
No. Baths
No. Floors
No. Rooms
Rec. Room
WATER
CERTIFICATE
of EXEMPTION
SEWER
Req'd.
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 authority to violate or cancel the provisions of any other .te or local law regulati construction or the
performance of construction.
DATE
a -
s-Ro
SIGNATURE
ntoote
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
Env. Health •-'-
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIA(CNDITIONS:
DATE
FFICIAL41C)±a+\I��rY1/*
APPROVED FOR ISSUANCE
R ec'd.
Not Req'd.
FEES COLLECTED
Single S
Building
Plumbing
Mech.
�U
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $q'[/CJ!°
PERMIT NUMBER
M w-- ao5
DATE
c -
04* *9.00
*9.Q0 rn
*9.O06i
E *000
9Q4R
01-06-80
B 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS, BECOME A PcRMIT.
0'1—i0 -'80' 90.5 *9.00°1
DATE REMARKS
RECORD OF INSPECTIONS
Final Inspection
INSPECTED BY
J—CP—g0
d00R