1981, 09-03 Permit: 81A-8863 Heat PumpPLAN NUMBER APPLICATION/PERMIT PERMIT NMBER
SPOKANE COUNTY - BUILDING CODES DEPARTMENT l �G 3
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
t—/ APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. Z LEGAL DESCRIPTION — SEE ATTACHED
LOT I BLOCK ISUB51VISION PARCEL NUMBER/S
2.
OWNER PHONE
3. +l `Ni
ADDRESS ZIP Actual Set Backs in Feet
�5 North South East West
CONTRACTORPHONE
-� Z Z
Size of Parcel
Zone Classification
4. ADDRESS CT
�, , � � (D1
ZIP
01 R ZG
Type Const.
Occupancy
Sp rinklered
❑Yes [–]No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
Main Floor Upper
Floors I
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
6.
Baths
No. Stories
No. Rooms
No. of Dwellings
TYPENo.
❑ NEW ❑ALT. �D'N. ❑ RPL. ❑ MVE.
7 OF ❑ OTHER
❑ BLD. ❑ PLMB. MECH. ❑ M. H. ❑POOL
CERTIFICATE
Req'd.
Rec'd.
Not Req'd.
WORK
of EXEMPTION
I
DESCRIBE WORK
—
Enum. Dist.
Location (Area)
FEES COLLECTED
8
VALU TION
SOURCE
GAS
ELECTRI
WA
SE ER
Ownership
USE CODE
9.
UTILOITIES
Public ❑ Private ❑
Single $
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 complied with whether specified herein or not. The granting of a permit does not presume
Building
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
r1ATF (1F APPI Ir:ATION 9-1- �I SIt;NATI IRF C]F APP (RANT /<Q�i�IJC� U iJT`�'�.�Lr1LlJ
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
gineer
Utilities
Plans Examiner
SEPA Checklist
PERMIT IS NONTRANSFERABLE
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ O
04* * 1 4.00
*14.00 ui
* 1 4,006
A *C.00
886.22
09-03-81
z 6,479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
8 8 6 3 z
*140000► -