1979, 09-21 Permit: 79-4493 Heat PumpPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
1.
2.
3.
4.
LOT
BLOCK
i%Dili •//14 -
SU DIVISION
LEGAL DESCRIPTION — SEE ATTACHED
5.
OWNS/
ADDRE
CON"FOR
-ADDRESS
/'
,f)ar•
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North !South East (West
G -
DESIGNER
PHONE
3,7S -51s-2'3.6
PHONE
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area `Basement Area Garage Area I Storage
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
8.
TO
Split Entry
Split Level
Rancher
❑ NEW ❑ ALT. -AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. A MECH: ❑ M.H. 0 POOL
DESCRIBE WORK
VALUATION
Source
of
Utilities
AP/
0 OTHER
ELECTRIC
No. Baths
No. Floors
No. Rooms
Rec. Room
WATER
CERTIFICATE
of EXEMPTION
SEWER
9.
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 g •sting of a • ' mit does not presume
to give authority to violate or cancel the provisions of any other state or o».I law reg ating construction or the
performa ce of construction.
DATE S ` S)GNATUR
Req'd.
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
Eq—°21 79 OFF ICIAL.R` ,24--)
APPROVED FOR ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ "i>
PERMIT NUMBER
Al 79 q3
04* *9.00
*9.00
*9,00eN
E *GOO
449.2
09-21-79
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
9 -21-7.9
449,30 *9.p0