1979, 10-19 Permit: 79-6377 Heat PumpPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
J 1:
2.
3.
JOB ADDRESS
5: (\i\
LEGAL DESCRIPTION - SEE ATTACHED
LOT
BLOCK
SUBDIVISION
OWNER Lc
ADDRESS
16 1 5 I An.
PHONE
ZIP
PARCEL NUMBER/S
Required Set Backs In Fee
North
South
East 'West
CONTRACTOR
ADDRESS
9309
DESIGNER
PHONE
9a.-'6 5a
ZIP
g 9 )--o Cp
PHONE
Size of Parcel
Type Const.
Valuation
Occupancy
Zone Classification ,
Sprinklered
•❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Ranche
TYPE
7. OF
WORK
❑ NEW 0 ALT. 0 AD N. 0 RPL. 0 MVE.
❑ BLD. 0 PLMB. ❑ MECH: 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floo
No. Room
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd
Not Req'd.
DESCRIBE WORK 1
8. a 4—L r. h -c 6 (4-t.a.wcR
VALUATION Source
of
9. Utilities
GAS
ELECTRIC
kx
WATER
SEWER
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 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
performance of construction. JA
1 �,,,
DATE SIGNATURE ��/r '1�IJ'�SL.Y A k' S -1Lc1X(x_.lY
DEPT.
SPECIAL APPROVALS -
REO'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Enginee
\Utilities
-me Clearance
hecklist
SPECIAL CONDITIONS:
DATE
APPROY[B FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. ? G 0
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 1'
M
PPERNWUMBER
77
DATE )ii -1I' -79
l64.* .*9.00'
6176#06440U
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS,Bg`o pA7 F,RM IT.
617: 7 Z * 9.0, 0,2