1979, 10-04 Permit: 74-5322 Heat PumpV
PLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / 1509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES
PRESS HARD TO MAKE 4 COPIES
1. JO RES L?L/� . (/laki
LOT 1 BLOCK SUBDIVISION
2
LEGAL DESCRIPTION - SEE ATTACHED
3 &441(i -/10* --
AD /1:5
SS
L;y CTOR
OWN
PARCEL NUMBER/S
ZIP
'x'
Required Set Backs in Feet
North (South
East
(West
AIS /
l
PHONE
/5 -c5 -
Size of Parcel
Type Const.
Occupancy
Zone Classification
Sprinklered
Dyes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
8.
. 9.
❑ NEW
❑ BLD.
❑ ALT.
El PLMB.
ILJ AD'N.
giMECH:
DESCRIBE WORK
ei
VALUATION
Source
of
Utilities
❑ RPL. ❑ MVE.
❑ OTHER
❑ M. : ❑ POOL
No. Baths
No. Floors
No. Rooms
Rec. Room
GAS
ELECT CX. `�
X 1
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 gr.nting of a rmit does not presume
to give authority to violate or cancel the provisions of any other state I law re ating co : ' uction or the
perfor nce of cons ction.
DATE / 7
DEPT.
p
SIGNATUR
or
'l
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health.,
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE io 7� OFFICI
I/ rrr r APPROVI
FOR ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
DATE
PERMIT NUMBER
04*
E
53212
10-04-79
2 6479,
* 9.00
* 9.00
*9.006
* 000 n
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
I0-.041-79
53Z2z *9.002
CC
1—
c-7
(.1)
w
rn
DATE REMARKS
RECORD OF INSPECTIONS
Final Inspection
INSPECTED BY
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