1984, 03-01 Permit: 84A-1754 Heat PumpPLAN NUMBER APPLI(CA TION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER
�A
TYPE 13 NEW 1:1 ALT. 1:1 AWN. ❑RPL. ❑ MVE.
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
No. Floors
STREETADDRESS�
�
No. Dwellings
PARCEL NO.
r„
) Cf 2-12-
LOT
BLOCK
SUBDIVISION
I
Number
LEGAL DESCRIPTION:
2.
or Variance
Received
Yes No❑
8 DESCRIBE WORK J `
a t IC S4S1_efnni
OWNER ''))
PHONE
PHONE
IWt t 1 %} 'o i:,
Yes❑ Not Applic. ❑
Received ❑
VALUATION I SOURCE GAS ELECTRIC PUBLIC E] SEPTIC Ownership
9•
FEES COLLECTED
AILING DRESS
�l
ZIP (
4
Actual Set Backs in Feet to:
140 .
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
`7 A f
North South East West
work will be compiled with whether specified herein or not. The granting of a permit does not presume to give au-
NTRACTO
l
NSE EXPI ES
M.-S4
PHONE
�] �j
Size of Parcel
Zone Classification
Residential 11
4.
h v t L: Gl
• 3
Mach.
Commercial ❑
ADDRESS
PRELIM. FINAL DATE
ZIP
Type Const.
Occupancy
Sprinklered
4Z-" L YY1 S� l aN 3
G lC N49
Y t Z 0Z
Planning
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
Prevent.
Engineer
Other (Specify)
ADDRESS
TOTAL $
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
WHEN MACHINE VALIDATED IN
CHANGE OF USE FROM
TO
THIS BECOMES A PERMIT.
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
PERMIT NUMBER
�A
TYPE 13 NEW 1:1 ALT. 1:1 AWN. ❑RPL. ❑ MVE.
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
%. 11 OTHER
OF
WORK El BLD. 11PLMB. ElMECH. ElM.H. El POOL
Certifi. of Exempt.
—7
Required
Yes No El
Number
or Variance
Received
Yes No❑
8 DESCRIBE WORK J `
a t IC S4S1_efnni
Shorelines/ Flood Hazard
Plans Required ❑
IWt t 1 %} 'o i:,
Yes❑ Not Applic. ❑
Received ❑
VALUATION I SOURCE GAS ELECTRIC PUBLIC E] SEPTIC Ownership
9•
FEES COLLECTED
UTILITIES PRIVATE ❑ SEWER ❑ Public ❑ Private ❑
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 type of
work will be compiled with whether specified herein or not. The granting of a permit does not presume to give au-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQU RED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT '— `'�'" DATE-`!'
Mach.
SPECIAL APPROVALS SPECIAL C NDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
Engineer
Other (Specify)
Utilities
TOTAL $
SEPA
WHEN MACHINE VALIDATED IN
THIS SPACE,
Plans PERMIT IS NONTRANSFERABLE
THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech IN 180 DAYS
%� DA41sii E6 1 — r' '? PERMI} t�b.5 4 'j 'ir 7 7r i f1 CrOTAL
CL
C
LL
LL