1985,04-29 Permit App: 00005134 WoodstoveMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied 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 state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
APPLICATION
OWNER OR DATE
Project # l
Owner's Name Last First MI
/0/4-0 C. J ?4AJ n
Project Address (Street Name & Number)
n, 1/042.2 /r/It u /E -w
City ate
5/op /64mde WAs'h.
Subdivision/Plat Name
-rattzAc2rt,c--, 40._I)
Assesso'ir Parce
c35�f2l# -6753
Lot
Block
Plat#
Applicant
''o hit.) if . ,e6
Address
e•//o.72Fig/.P v/,c�cc)
City State
r,
Sip/Cry yE WAsA
Zip
` -2 a 6
Phone
%2,or — 36.5—,
6/114 /en/Z ./?-1�9 s DAs z Y
Business Phone
Contractor
`'V
'
Address
City
State
Zip
Phone
Contact
License #
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/V leod Stove
Air Handling Unita
0-10,000CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10v,:.00+BTU
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied 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 state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
APPLICATION
OWNER OR DATE
fir ir331,ti'.'r.��,...1�,�
�E
PEF
S1GNLU:
(lcl,'Ir(lli�
SpO���(1C' �,�)l1HCy
ll1 ,)1 !)Elild111
.1Antt's 1 n1ANSO'. 1)IRI-,-rr,l<
WAGE D[Si'r)i_ Si`,tEM INF;,MA'IONAL kE-Vlt-`r Fahr++,
i , wily
Un S i to Sewage Disposal System
Describe Proposal: kt->C1'.4-rtAL. LA
Property Owner GALE.
Road Name Car2.0oC "P-474.12)
Parcel Number iSS22.-g033
Street Address N they -z. rrpu6
Legal Description: N.44O' c Nw54 Or NtaYs- ;•)w-'/4 Exc.W:4'
F N ZZao' ! CKC • 4 Qo u C 12D
Prop
i
1. An initial review of the above -referenced property has been
conducted by the Spokane County Planning Department and the
f(ll inwin(. items are noted. An in-depth review of the property will
ayaln t)1 made at the time a building permit is applied for.
ed Owner or Authoriz ed Re(esentati ve
Dat e,IQ�!7 t/
Pequi rernents reviewed for property as of the date set forth
hr•r1nabove.
Ded Latory Language within i ldt
5 Su:),l ect Property is Lt'rr.l l ly
silicate of Exemption
'I lho1 17 r'(1 `.f$ I fl i;
Mo' l_ In L (:ill fl i. :.1 r (1 1 r. r
1 1 1! 5 I'r'r11111 Ke(.151 rf'(1
r I?( qui red fori Fol l ov11 nu r;�cses
AA
0
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L. An
h( `1p11k
h (
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v W rl,•
;i r r)pe r ty hd',
n rl t -i n i H'
p r 11r1
'1r hul l(l1r1 porm11 aflp! led for.
Vcl r l a nC (' Hui remen t S
Utner:
i ; w 1 n �' ' '• t l l'. .i r
Engineer's Oft Date: /o
3. The Spokane County/iepartment of Building and Safety has advised
the property owner/representative that at such time a structure or
building is to be placed/constructed on the property, a building
permit will be required.
Building and Safety Department:
Date: /6.24-8Y
NOTE: The review by the various departments as provided for herein
is solely for the purpose of advising the Spokane County Health
District of the subject property's compliance with various codes and
regulations. The issuance of a permit by the Spokane County Health
District for the installation of an on-site sewage disposal system is
not to be considered as a vesting of a right by the owner/rep-
resentative to obtain a building permit for the property. At the
tim( that ,1 building permit is applied for, the subject property must
comply with all applicable federal, state or local laws, ordinances
or regulations with the exception of those relating to the issuance
of a permit for the septic tank/drain field on-site sewage disposal
system by the Spokane County Health District, pursuant to this form.
+rcordinyly, although as of the date of this document the subject
p1(tllerty may me('r certain federal, state or local laws, ordinances or
r utations, in the event such items change between the date of this
i;� curter' an;1 too appl1c_dtion for <1 bul ldin(j l,o0111 t, the ow-
ner/representative will be responsible for- meeting such regulations
r)n 0 ,±.4 o f ,tall I 1 1 On f (. t; 1 1 i.