1980, 05-05 Permit: 80-4293 Heat Pump, FurnacePLAN 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
1.
2.
JOB ADDRESS
ccg
LOT
BLOCK SUBDIVISIO
r-
LEGAL DESCRIPTION — SEE ATTACHED
3
4.
OWN
ADD
CONTRACTOR nn
PHONE
ADDRESS
DESIGNER
5' ADDRESS
PHPNE
J /-'/975"
ZIP
age
PHONE
PARCEL NUMBER/S
Required Set Backs in Feet
North (South LEast (West
Size of Parcel
Zone Classification
Type Const.
Valuation
Occupancy
Sprinklered
:Nees ❑No ❑ Req'd.
Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
TO
Z'N.
Split Entry
Split Level
Rancher
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WQR
8.
VALUATION
9.
U / / e
ELECTRIC WATER
WATER
Source
of
Utilities
7
GAS
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.
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:
4:1—
DATE*En
OFFICIAL�11,Y�
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
DATE )7/
u4*
* 13.00
* 1300 5
* 1 3.00M
E *0,00
429.22
05-05-80
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
* 1 5. 0 '0 °