1988, 02-22 Permit App 88000296 MHSPOKANE COUNTY DEPARTMENT OF BUILDING AND SAFETY
NORTH 811 JEFFERSON
SPOKANE, WASHINGTON 99260
(509) 456-3675
I certify that I have examined this permit and state that the information contained in it and submitted by me or my agent to compile said permit is true and correct. In
addition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE provisions included herein and agree to comply with same. All provisions of laws and
ordinances governing this type of work will be complied with whether specified herein or not. I understand that the issuance of this permit and any subsequent inspection
approvals or Certificates of Occupancy shall not be construed to give authority to violate or cancel the provisions of any state or local law regulating construction, or as a
warranty of conformance with the provisions of any state or local laws regulating construction.
SIGNATURE OF
APPLICATION
OWNER OR AGENT DATE
INFORMATION WORKSHEET
PARCEL NUMBER : / .5 — .' 7 �0
STREET ADDRESS : /7207 05?-Q-
CITY/STATE/ZIP: _`��/5i, / t7/c ,. - 9'9(i/�
SUBDIVISION: )3CIc007is
BLOCK: LOT: ZONE: DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
# OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT:
OWNER: / /7",4/, 4_ G//.4,Pj PHONE:
MAILING ADDRESS: , /7 / 7 ,eroAa/zej i
CITY/STATE/ZIP:
CONTACT:
y7'7 >4 - 9Y4/l
PHONE: % - -
SETBACKS: - FRONT: LEFT: RIGHT: REAR:
PERMIT USE:
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CONTRACTOR LICENSE NUMBER:
CONTRACTOR:
MAILING ADDRESS:
BUILDING INFORMATION
PHONE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS:
NEW: REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT.:
REQUIRED PARKING:
# HANDICAP: SEWER (Y/N): HYDRANT:
1 /00
PLUMBING INFORMATION
CONTRACTOR LIC#:
CONTRACTOR:
MAILING ADDRESS:
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CONTRACTOR LIC#:
CONTRACTOR:
MECHANICAL INFORMATION
MAILING ADDRESS:
ELECTRIC: GAS: OIL:
ENERGY CODE: WSEC:
CCAL: WOOD: SOLAR: HEAT PUMP
NWEC:
UTILITY: SGC:
APPROACH: PRESCRIPTIVE: POINT: COMPONENT: SYSTEMS:
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MECHANICAL FEES
ITEM DESCRIPTION
PROCESSING FEE
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
GAS HTG EQUIP(100,000)BTU
GAS HTG EQUIP +100,000
GAS PIPING - # OF UNITS
HEATPUMP 1-100 BTU
HEATPUMP 101-500 BTU
HEATPUMP 501-1000 BTU
HEATPUMP 1001-1750 BTU
HEATPUMP +1751 BTU
REFRIG 1-100 BTU
REFRIG 101-500 BTU
REFRIG 501-100 BTU
REFRIG 101-1750 BTU
REFRIG +1750 BTU
AIR CONDITIONER 0-3 HP
AIR CONDITIONER 3-15 HP
AIR CONDITIONER 15-30 HP
AIR CONDITIONER 30-50 HP
AIR CONDITIONER +50 HP
VENTILATING FANS
EVAPORATIVE COOLERS
HOODS
CLOTHES DRYER
RANGE
GAS LOG
UNLISTED GAS APPLIANCE
AIR HANDLER 1-10000 CFM
AIR HANDLER 10000 CFM
NUMBER OF
YES OR NO
PLUMBING FEES
ITEM DESCRIPTION
PROCESSING FEE
TOILETS
SINKS
SHOWERS
BATH TUBS
KITCHEN SINKS
DISHWASHERS
GARBAGE DISPOSAL
CLOTHES WASHER
UTILITY SINKS
ELECTRIC WAXER HEATERS
FLOOR DRAINS
FLOOR SINKS
BAR SINKS
ROOF DRAINS
LAWN SPRINKLER
SEWAGE EJECTOR
WATER SOFTENER
URINAL
DRINKING FOUNTAIN
NUMBER OF
YES OR NO