1980, 09-10 Permit App: 80-9965 Heat Pump, FurnacePLAN 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 3 COPIES
JOB ADDRESS
1. E. q ��r��
LOT BLOCK SUBDIVISION
2.
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
3.. -- Nl EIV I_
ER PRI SES
ADDRESS _
SPRRkiL4E
CONTRACTOR
AA -1 NERTiw4 ei Aid konlp, IIhC'.
4' ADDRESS
E, 5 WEIL_E
DESIGNER
PHONE
ZIP
PARCEL NUMBER/S
Actual Set Backs in Feet
North [South [East (West
PHONE
lP
l,99C )
Size of Parcel Zone Classification
PHONE
Type Const.
Occupancy
Sprinklered
:Yes ❑No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
5' ADDRESS
ZIP
Main Floor I Upper Floors Garage Area
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Storage
Unfin. Basement
NEW
❑ BLD.
❑ ALT. ❑ AD'N. ❑ RPL. 0 MVE.
0 PLMB. X.MECH. 0 M.H. ❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
DESCRIBE WORK
8. I ti_STA LL HEAT P
VALUATION
9.
SOURCE
OF
UTILITIES
FLIRNi liC
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Rec'd.
Not Req'd.
GAS ELECTRIC
XX
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 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
174,1 9/0/Bo
SPECIAL CONDITIONS:
art
' 00 fez' APP2o (16703V AWA/Z0 0o,zs
A
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ `1.00
111
PERMIT NUMBER
80 - 9965-
02*
965
02* *9.00
*9.00 rn
*9,006
A *0,00 8
992.92
09-10-80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0.9Fa. 8.0 996,5 *9,002r -
DATE ISSUED PERMIT NO. TOTAL
FILE COPY