1983, 06-17 Permit: 83A-5489 Heat PumpPLAN NUMBER APPLICATION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS ��
PARCEL NO.
�. jr �-
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Utilities
Plans
Exam.
Building
Tech. ' •�
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
SEPA
Modular/
MFG. Home
PERMIT NUMBER
�:-
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACI
THIS BECOMES A PERMIT.
J6 -17-j7)548.92
DATE ISSUED PERMIT NO.
*1400°
TOTAL
Y
a
0
V
W
J
LL
OWNEI
_J
ZCv -c3
3
ZIP
Actual Set Backs in Feet to:
MA!UNG ADDRESS
i • 1 r
North South East
West
CONK j /
LICENSE EXPIRES
HO E
Size of Parcel
Zone
Classification
Residential ❑
Commercial ❑
4.
AD RESS
bJ
S-� ( -
ZIP
Z c� h
Type Const.
Occupancy
Sprinklered
Eyes ❑No ❑Req'd.
t 2' z t,UG
Total Bldg. Floor Area
PHONE
New Const. Valuation
Remodeled Valuation
DESIGNER
5.
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
ADDRESS
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basem
CHANGE OF USE FROM
TO
6'
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE. ❑ OTHER
Number
],
OF B.0MECH. ❑ M.H. ❑ POOL
Certifi. of Exempt.
Required
Yes❑ No❑
WORK ❑ BLD' El
or Variance
Received
Yes No❑
Shorelines/ Rood Hazard
Plans Required
❑
8
DES R!jp E W K
�� In
Yes NotApplic.
Received 7
VALUATION
OURCE
GAS ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9•
UTILLIITIES
PRIVATE 11
SEWER
public ❑Private El
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
Building
work will be complied with whet specified herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel th ro isions of any er state or local law regulating construction or the performance
plumbing
of construction. SEE REVERSUID.E FOR RE RED INSPECTIONS
APPLICATION 3
SIGNATURE OF DATE
Mech.`
OWNER OR AGENT
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Utilities
Plans
Exam.
Building
Tech. ' •�
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
SEPA
Modular/
MFG. Home
PERMIT NUMBER
�:-
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACI
THIS BECOMES A PERMIT.
J6 -17-j7)548.92
DATE ISSUED PERMIT NO.
*1400°
TOTAL
Y
a
0
V
W
J
LL