1991, 12-19 Permit App: 91008725 SewerSPOKANE COUNTY DEPARTMENT OF BUILDINGS
W. 1303 BROADWAY AVENUE
SPOKANE, WASHINGTON 99260
(509) 456-3675
I certify that 1 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, or as a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
PROJECT NUMBER, -
PENALTIES
... rmnxstt irtr^i xn.. - 11110“
DATE= 12/i PAC
Ti'i:l' IS NOT A PERMIT ai}iriai}i}e
SE:: 1, FOR COMMENCING !.IOf2l! WITHOUT 1^t PERMIT
SITE: ST f't Ei:i:::i'=': 1 e)i S BLAKE F?D
ADDRESS: 1:I
WA 99216
PARCEL.::_. 27541 10:31
PERMIT Ui i..:=: SG 'EP is:ONNElCTION .... WOI._FCRf.E:ST (91S--142)
di if}i. EE.
41, OE
PL_A T v:== 002
r1LOCR= i
ARE H:=
iii. DGL".
1
PLAT NAME= VERA
LOT= ? ZONE=C'li.RI
F/A=:: F " WIDTH=
DWELLINGS= i WATER DIST -
PHONE=
OWNER= ROSE LARRY 0
S i Rl[ I T::.: 1612 .i BLAKE RD
ADDRESS- S''i11: ANE WA 99216
CONTACT NAME= H
BUILDING SETBACKS i ltCii.:T:. NIA LEFT= N/A RIGHT= N}/1-) ,tl iii
R/W=
1STRUCTION PHONE iNiL!MBER = 509 926 Ei '64
}i 1i. )i. )t h,.. **X *
CONTRACTOR= i4
STREET= ,i .{ ,...i i
ADDRESS='1-'ti FINE
SEWER FERMI MM.i: T
:INSTRUCTION
.+EiLL_E::YUJAY AVE:.
WA 99206
.I: TEM DESCRIPTION
PROCESSING FEF
SEWER CONNECTION
PERMIT
.T..Y,FE.
SEWER PERMIT
I'i;i?CEE;
D
ft diia dt-- u }@ 'Pr
}t ./1'. X. li M 9i -)t'
PHONE = 509 '::' ?rr 8964
QUANTITY FEE AMOUNT
Y'
10.00
1 40.,e°
FEE AMOUNT AMOUNT PAID AMOUNT OWING
50.00 .00 50.00
50,00 .00 50,00
BY: 11111"1 .1, I P O V 11' i -i , ROBIN
BY: rDOMITROtdI:isHi, ROBIN
SEWER STUB a-1, LT INFORMATION IS A'VA].!._ADL.EE AT THE COUNTY
UTILITIES MN; MINI (456--3604)
C:TiN_(i;,Ar:'.TCiE. OR '1i=,!:,i...:i:Cr'1NT IS TO F:i:i.i:L..1)
ELEVATION id AND i'OS:ETION OF SEWER
ExcpwATIoN
10 LOCA (E:: BURIED CAEL.EES, GAS PIPING , WATER I i JE..SE.IC.T. ..
YOU Y:.
CALL BEFORE T l Ti .I l.r (456-0000)
SEWEEF! :'"i'U82? ARE TO BE CHECKED PRIOR
TI iAT 7!'if.EY AE<E 1(Ti:OOrNECTION iTOII
NSURE
nN
)6»}}4 :tl—_ OR INSPECTION PRIOR:10 ,CtF;xvtt}}xx}n
9@}k*****}t'x' 24 HOUR NOTICE REQUIRED
*.ii.}i..x..k}i.}{.p;..x.
(TE Ai
:I:f?R I is
C;PNF'IRM THE:
IrNY OTHER
THANK YOU
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