1979, 09-21 Permit: 79-4497 Heat PumpPLAN NUMBER
APPLICATION/PERMIT �rI
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 DATE / / //7.
PERMIT NUMBER
79 ---14f7
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
LOT
BLOCK
. yaps /VI J
SUBDIVISION
2.
3. ADN
ADDRESS /f���'
CO r;ACTOR /
Les. atsinita.isr/
/
LEGAL DESCRIPTION - SEE ATTACHED
PH NE
a4a��y
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South East 'West
A•E RESS''''�'')^�
O�
DESIGNER
6' ADDRESS
PHONE
3aS //sac
ZIP7fdo
PHONE
Size of Parcel
Zone Classifl cation
Type Const. , Occupancy
Sprinklered
Oyes ❑No 0 Req'd.
Valuation I Building Area In Sq. Ft.
ZIP
OWL Area I Basement Area r Garage Area I
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
8.
9.
❑'NEW
0 BLD.
DESCRIBE WORK
VALUATION
❑ ALT.
❑ PLMB.
TO
Source
of
Utilities
❑ RPL. ❑ MVE.
❑ ❑ 0 OTHER
POOL
GA
LERIC
Split Entry
No. Baths
Split Level
No. Floors
No. Rooms
Rancher
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 or ances governing this
type of work will be complied with whether specified herein or not. The . ting of a p emit does not presume
to give authority to violate or cancel the provisions of any other state or oc. law regu ting const r on or the
performance of construction.
�9
DATE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
SIGNATUR
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATI7-21—n OFFICIA /
APPROVED .FOR ISSUANCE
Recd.
Not Req'd.
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
• of -d
TOTAL $
04* *9.00
*9.00 En
*9006
E *000 8
449.68
09=21.-79
B 6479.
p
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09-2117719 4'49,7 z *9.0,0;a