1992, 03-10 Permit App: 92001406 SewerSPOKANE COUNTY DEPARTMENT OF BUILDINGS
W. 1303 BROADWAY AVENUE
SPOKANE, WASHINGTON 99260
(509) 456-3675
I certify that I have examined this permit/application, state that the information contained in it and submitted by me or my agent to compile said permit/application is true
and correct, and authorize Spokane County to proceed with processing 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/application 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, oras a warranty of conformance with the provisions of any state or local
laws regulating construction
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
PROJECT NUMBER= 92.001 406
APPLICATION DATE.= 03/10/92 PAGE= 01
****** THIS IS NOT A PERMIT ******
FI:::NALTIF::,S WILL BE: ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE .STREET= 623 S BLAKE RD PARCEL4= 22541-0719
ADDRESS= SPOKANE WA 99216
PERMIT USE= SEWER CONNECTION -- SOUTH BLAKE:: (92S -17i)
*** SEE NOTE ***
PL.AT4= 001669 PLAT NAME= MOORE'S SURBURBAN HOMES ADD
BLOCK= 3 LOT= 7 ZONE= UR 3.5 DIST'#= F
AREA= F/A= F WIDTH= 103 DE::F'TFI- 120 Fi%W= 50
s OF BI_iiGS= 4 DWELLINGS= 1 WATER DIST
OWNER= SEXTON, BILI...
STREET= 623 S BLAKE RI)
ADDRESS= SPOKANE WA 992.16
CONTACT NAME= H h S CONSTRUCTION
PHONE= 509 926 0290
PHONE NUMBER= 509 926 8964
BUILDING SETBACKS: FRONT- N/A LEFT= NiA RIGHT== N/A REAR= NiA
********If*#*
******** SEWER PERMIT
CONTRACTOR= H & S CONSTRUCTION
STREET.== 11817 E VAL_LEYWAY AVE
ADDRESS= SPOKANE WA 99206
ITEM DEi:SCRIPTION
PROCESSING FEE
SEWER CONNECTION
*******'***********
PHONE= 509 926 8964
QUANTITY FEE AMOUNT
Y 10.00
1 40.00
PERMIT TYPE:: FE::F.:: AMOUNT AMOUNT PAID AMOUNT OWING
SEWER PERMIT 50.00 .00 50.00
50.00 .00 50.00
*********
PROCESSED BY: DOMITROVICH, ROBIN
PRINTED BY: DOMITRO'VICH, ROBIN
SEWER STUB AS—BUILT INFORMATION IS AVAILABLE AT THE COUNTY
UTILITIES DEPARTMENT (456--3604)
CONTRACTOR OR APPLICANT IE TO FIELD LOCATE AND CONFIRM THE
ELEVATION AND POSITION OF SEWER STUB PRIOR TO ANY OTHER
EXCAVATION
TO LOCATE BURIED CABLES, GAS PIPING, WATER LINES, ECT.
CALL BEFORE YOU DIG (456-8000)
SEWER STUBS ARE TO BE CHECKED PRIOR TO CONNECTION TO INSURE
THAT THEY ARE CLEAR AND UNOBSTRUCTED TO THE SEWER MAIN
.*.***.***** CALL. FOR INSPECTION PRIOR TO COVER **********
********* 24 HOUR NOTICE REQUIRED **3i*******
********* 456-3604 **********
***************3i*3i•*3**#********* THANK YOU************'********'**3e****3E**.**.*
PLUMBING PERMIT APPLICATION FORM
Information Werkshest
JOB STREET ADDRESS: 62-x✓' S • BG/ia
CITY/STATE/ZIP: 90.144,-46 RJ*- 99)-4
OWNER: /./..9. /// 4-7.4 ill SHS an--)
MAILING ADDRESS: Cc 2.3 s 61 -4v -F
(Street)
CONTRACTOR:
PARCEL NUMBER:
PHONE NUMBER: 924
�O' vl_,4,de td,4.-- 992-1C,
(City/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street)
(City/State)
(Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
TOILETS
SINKS .
SHOWERS
•BATH TUBS
KITCHEN SINKS
DISHWASHERS -
GARBAGE DISPOSAL
CLOTHES WASHER
UTILITY SINKS
:ELECTRIC WATER HEATERS`,;;;
FLOOR DRAINS
FLOOR
BAR SINKS
'ROOF DRAINS
LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE
SEWAGE EJECTOR ".;
WATER SOFTENER
URINAL
DRINKING FOUNTAIN
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE1 a `K
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
(
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
/
1 /
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS' TOTAL PERMIT
FEE DUE
=$
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675