1981, 01-12 Permit M81A-0315 Heat PumpPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
2.
3
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
,0'4 D _ �
LOT
OWNER
BLOCK
ADDRESS
SUBDIVISION
CONTRACTOR
4.
ADDRESS
DESIGNER
ONE
PI
ZI P
P ONE
?15Z
ZIP
`t'qZ
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South [East (West
Size of Parcel Zone Classification
Type Const.
Valuation
Occupancy
Sprinklered
❑Yes ENO ❑ Req'd.
Building Area in Sq. Ft.
5. ADDRESS
ZI P
Main Floor
Upper Floors 1 Garage Area
Storage
6.
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
1&NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. 0 PLMB. MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WOF En um. Dist.
VAL ATION? SOURCE USE CODE
9, IUTILLITIES
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 12, 2_4 SIGNATURE OF APPLICANT I)rA11k1 C�..
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
GAS
Env, Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ELECTRIC
xx
WATER
SEWER
Ownership
Public ❑ Private ❑
I Location (Area)
FEES COLLECTED
Single $
Building
Plumbing
Mech. t
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PtI<IV1I 1 INVIVIoc-rs
miblA
•
04* *14.00
*14,00 6-3
*14.006
A *000 0
31.42
01-12-81
6479,
l C) 0
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
315 *14'00°ae- -
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
01L12-g`l