1980, 06-02 Permit: 80-5347 Heat Pumpr
FLA BER -
APPLICATION/ PERMIT
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SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
PARCEL NUMBER/S
2.
]SUBDIVISION
I
OWNER,_
PHONE
3.
J `—�
J 3 i 1� .�-
ADDRESTS� n
ZIP
Required Set Backs in Feet
'tel
V `
LL
North South East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
4.
ADDRESS -
ZIP
Type Const.
Occupancy
Sprinklered
/
'y
I
❑Yes []No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
OWL Area
I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
TYPE 1(� NEW ❑ALT. 11AD'N.
ElRPL. ElMVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
�,
OF J�
❑OTHER
CERTIFICATE
Req'd.
Recd.
Not Req'd.
ElBLD. ❑ PLMB.
ElM.H. 1:1 POOL
WORK -NMECH;
of EXEMPTION
I
DESCRIBE WORK
8
:�—_
FEES COLLECTED
VALUAI IUN "Source GAS ELECTRIC WATER SEWER
of
9. Utilities X Single $
1 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 Building
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 state or local law regulating construction or the
Plumbing
performance of construction.
DATE �� SIGNATURE _ �� ( �ti ,.) 114 Mech. i
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD. Plan Check
Env. Health
SEPA
Planning
Fire Marshall
Mobile Home
Co. Engineer Other (Specify)
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDA'
THIS BECOMES A PERMIT.
SEPA Checklist
DATE OFFICIAL
ADDDrrtrrn rnD IccIIAI\lr`r
PERMIT NUMBER
DATE )
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