1980, 09-04 Permit: M80-9577 Heat PumpAPPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1.
LOT
2.
BLOCK SUB 7D
3.
4.
5.
OWNER
ADDRE
LtGAL DESCRIPTION - SEE ATTACHED
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CONTF2 TOR
A'6DR ESS
. C%7Ci
DESIGNER
PHIONE
ok- dip
ZIP
�7ai4
PHONE
PHONE
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South East 'West
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
Valuation (Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
ZAD'N. 0 RPL. 0 MVE.
0 OTHER
MECH.❑ M.H. 0 POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WO
8.
VALUATION
9.
K %Obi" /(2
SOU RCE
OF
UTILITIES
GAS
Enum. Dist.
Location (Area)
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
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. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION $'5' gU SIGNATURE OF APPLICANT 1'7CC0n.J/
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
(S.1 -Ad
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ qt(
H
PERMIT NUMBER
� - ?577
04* *9.00
* 9.00
* 9.006
E *000
957.62
09-04-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
G9 4:-)810 957,72 *9.00°
DATE ISSUED PERMIT NO. TOTAL
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