1983, 03-24 Permit: 83A-2194 Heat PumpPLAN NUMBER APPLIICATION /PERMIT [53z 5
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, Yt ASHNIGTON 99260 / (509) 456-3675 ,
APPLICANT: COMPLETE NUMBERED SPACES -PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OW ER PHONE PHONE
3. MAILIN(IADDFOESS ZIP Actual t Backs in Feet to:
North I South East West
9• ", UTILLIITIES PRIVATE ❑ SEWER ❑ I Public ❑ Private ❑
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 whether specified herein or not. The granting of a permit does not presume to give au-
thority 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
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE 3 Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning I
Fire
Prevent. \,
Engineer
Utilities
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building \ AIN 180 DAYS
Tec
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
TOTAL $ _—
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
`3-24-83 21;1,426
DATE ISSUED PERMIT NO.
rt400°�
TOTAL
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CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
Commercial 1-1
4.
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
t
'
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basemt
s.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE ❑ NEW
❑ ALT. ❑ AD'N.
❑ RPL.
❑ MVE.
7•
OF
❑ OTHER
❑ BLD.
❑ PLMB. ❑ MECH.
❑ M.H.
❑ POOL
Exempt.
Required Yes El No El
Number
WORK
or Variance
Received Yes ❑ No ❑
DESCRIBE W
"
Shorelines/ Flood Hazard Plans Required ❑
8.
C.
-
—
\ .
Yes ❑ Not Appl ic. ❑ Received ❑
VALUATION I SOURCE
GAS
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9• ", UTILLIITIES PRIVATE ❑ SEWER ❑ I Public ❑ Private ❑
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 whether specified herein or not. The granting of a permit does not presume to give au-
thority 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
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE 3 Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning I
Fire
Prevent. \,
Engineer
Utilities
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building \ AIN 180 DAYS
Tec
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
TOTAL $ _—
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
`3-24-83 21;1,426
DATE ISSUED PERMIT NO.
rt400°�
TOTAL
k
i �.
d
Q
C..1
W
J
U_