1980, 06-12 Permit: 80-5693 Heat PumpPLAN NUM ER
tiak
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT .
PERMIT NUMBER
M40— 13
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
1. S I7 3 J 7 7ne D�
LOT LOCK SUBDIVIS ON
2.
O3. wrvtt}�
DDR SS
LEGAL DESCRIPTION - SEE ATTACHED
CONTRACTOR 4 7
cia
eD?c,ri tkarrlL
DESIGNER
5. ADDRESS
clgq-en 7,0PHONE
97.V o
PARCEL NUMBER/S
Required Set Backs In Feet
North 'South East (West
Size of Parcel Zone Classification
PHONE
Type Const.
Valuation
Occupancy Sprinklered
❑Yes ❑No 0 Req'd.
Building Area In Sq. Ft.
•
ZIP
DWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
,Ir(PCD N. 0 RPL.
fe MECH: 0 M.H.
8.
VALUATION GAS
9.
Source
of
Utilities
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room.
CERTIFICATE
W'(`��r�+s''`,'/'T/ of EXEMPTION
ELECTRIC W ER
Req'd.
Re 'd.
Not Req'd.
SEWER
I hereby certify that I have read and examined this applica ion 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.
DATE - SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
FOR GAS:
PIPE SIZES:
PIPE LENGTHS:
BTU'S:
DATEIP/>IiT/Sn OFFICIAL
5.L71A/1/Y V
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
_y Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $OD
04* .
*9.00
*9,00
'*9.0(M
*000
56922-
06=•1 2-80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOME e,,E MIT.•
b 6•=1 .."1611)5'6,9:3 5
*9.00=ap