1980, 02-11 Permit: 80-1040 Heat PumpPLAN 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
JOB ADDRESS .� �, LEGAL DESCRIPTION - SEE ATTACHED
TYPE ❑ NEW ❑ ALT. ❑ AD'N.RPL. ElMVE.
7, OF ElOTHER
WORK El BLD. ElPLMB. V MECH: ❑ M.H. ❑ POOL
K
equired Set Backs In Feet
OWNER
Orth South
PHONE
3.
c
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
Type Const.
ADDRESS
-+
ZIP
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
f_ i %
D-1 60—
Building Area in Sq. Ft.
JJconstruction.
11
DATE I --`t — SIGNATURE _ .l � —+� — —r �1 Q 0 71
T ' Mech.
CONTRACTOR
DWL Area
PHONE
Garage Area
Storage
Env. Health
4.
ADDRESS
Split Level
ZIP
Mobile Home
;� 9 3o
Fire Marshall
CID
No. Baths
DESIGNER
I No. Rooms
PHONE
5.
Zone Clearance
CERTIFICATE
ADDRESS
Recd.
ZIP
of EXEMPTION
CHANGE OF USE FROM
TO
6.
FEES COLLECTED
TYPE ❑ NEW ❑ ALT. ❑ AD'N.RPL. ElMVE.
7, OF ElOTHER
WORK El BLD. ElPLMB. V MECH: ❑ M.H. ❑ POOL
K
equired Set Backs In Feet
Source
of
Utilities
Orth South
East West
i z e of Parcel
Zone Classification
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
Type Const.
Occupancy
Sprinklered
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
❑Yes ❑No ❑ Req'd.
aluation
Building Area in Sq. Ft.
JJconstruction.
11
DATE I --`t — SIGNATURE _ .l � —+� — —r �1 Q 0 71
T ' Mech.
DWL Area
Basement Area
Garage Area
Storage
Env. Health
SEPA
Split Entry
Split Level
Rancher
Mobile Home
Fire Marshall
No. Baths
No. Floors
I No. Rooms
Rec. Room
TOTAL $
Zone Clearance
CERTIFICATE
Req'd.
Recd.
Not Re(
of EXEMPTION
a 4 z
FEES COLLECTED
;j PERCMmITT NUMBER
SI ,L 0 �' t C) \ V
DATE 2-- c _ K;
04* *9.00
*
9.00
*9.00
E *0,00
1 03.9-9
02-11-80
;? 6479.
VALUATION
9,
Source
of
Utilities
GAS-
ELECTRIC
x x
WATER
SEWER
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 Building
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
Plumbing
performance of
JJconstruction.
11
DATE I --`t — SIGNATURE _ .l � —+� — —r �1 Q 0 71
T ' Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT_ REQ'D. REC'D. Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Co. Engineer Other (Specify)
Utilities 9
TOTAL $
Zone Clearance
IN THIS SPACE,
WHEN MACHINE VALIDATED
SEPA Checklist THIS BCfOIjAF�$�p.EORMIT.
�jj
1 O
do—it UU
a 4 z
APPROVED FOR ISSUANCE
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