1980, 04-17 Permit: 80-3611 Heat PumpPLAN NUMBER
CAI
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
1.
2.
3
JOB ADDRE/ 7/ 7 !�
LOTS BLOCK SUBDIVISION
�-/,l
LEGAL DESCRIPTION - SEE ATTACHED
OWNE
ADD
Gtr ,a: a.�.J2>
PHONE
qgq . `3/0
29,010,6
PARCEL NUMBER/S
CONTRACTOR
4. A/YQS-rn.o If�ccrf..n9'
�o5.7 try t7t1
DESIGNER
5.
P ONE
ao
PHONE
ADDRESS
ZIP
Required Set Backs in Feet
North 'South [East 'West
Size of Parcel I Zone Classification
Type Const. Occupancy Illrll Sprinklered
❑Yes ❑No 0 Req'd.
Valuation Building Area in Sq. Ft.
DWL Area I Basement Area Garage Area Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
❑ NEW
LI BLD.
❑ ALT.
O PLMB.
AD N.
0 MECH.
❑ RPL.
❑ M.H.
O MVE.
O POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
8. DESCRI•
BE.WOj2K i`'%C2/ �[a /t&_ t- ERS' �`�,4SE WE fp
VALUATION Source / /CT
of
9. Utilities
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:
DATE'T/ 17' N J OFFICIAL r Ca. ne.Vs
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
cy
Oa
Ckt
DATE 1///7 / Fd
PERMIT NUMBER
3Cn
04* •*9.00
*9,00
*9.006
E *Q00 8
361.02
04-,17-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
14:117;!-4 p, 3'611
* 9. IM
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