1991, 03-26 Permit: 91001328 Refund_J
SPOKANE 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 perm it/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 subsequen •nspection 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 constru • on, or as a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OFAPPLICATION
OWNER OR AGENT "ATE
PROJECT N1MBER:91001320 APLl(lTION DATE= 03/26/9i
3*)*)*3*•it;r THIS IS NOT A PERMIT ******
PENALTIES WILL BEAS ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
l:` AGE :::; F) •
SITE STREET= .110 N FARR RD
ADDRESS= s SPOKANE WA 99206
PERMIT t.TAE::=:: SEWER CONNECTION .... A87-1
*)*k SITZ~ NOTE: 3*3*k:
P1..,A'T•:„::_: 001 835 Pt...AT• NAME= (:TPF •T•R . 1-354
BLOCK= LOT= r(:iWE..:::: Af : tJB DI,`>TN: I:::
AREA= 000000 00 t ,'`A-- E' WIDTH= DEPTH= j:'t,'W.
OE BLDGS= i :„ Dw:l..L.i:NGS=:: 1 WATER DIET ::..
r'ARCE::l..:;:= 17543-1732
OWNER::.: FEUFF INGER, ,J PHONE=
STREET= 110 N F A R R RD
ADDRESS= SPOKANE WA 9920/
CONTACT NAME= I...F:f.TN, RD;E' i••tOiNEE: NUMBER= 509 926 8964
BUILDING SETBACKS: FRONT=FRONT=NA LEFT=LEFT=NA RIGHT= Ni'i REAR= NA
)*)*.)*3*•k:a)r•fie*•kk•*•ir:)**)*3{*fi:)*•3d•3`:y:•**3i*#ri :iE::wE::R PERMIT k•*k•**••• *a,:)*),•)*•k•3sk:3* :k•)*;r.•*****>i31k:* ;
CONTRACTOR= H & S CONSTRUCTION
"`AVESTREET= = 1 'i �:D1 r 1. VAL.LE::YWA A
ADDRESS= SPOKANE WA 9920 >
PHONE= 509 926 G964
:I:TEi1 I:)E::gC::F<:r.I:''T:l:c)N QUANTITY NT:l..rY FEE:: AMOUNT
PROCESSING FEE ¥ 10,00
SEWER CONNECTION i ,I O . 0O
PERMIT TYPE
'EWER PERMIT
FEE AMOUNT AMOUNT RAID AMOUNT OWING
50,00
0 50,00
50,00 ,00 50,00
PROCESSED BY: JULIE illi i•T TCI
PRINTED TF::I•) B`(: JULIE ,SV•IAT'T(:i
SEWER STUB B A,t•...Z.{t.1:I:I...T INFORMATION MAT':rON 1:
UT :i: L.:r T' :rE::F DFPAR:'T• MENT 1456-3604 )
CC.iNTRc` C.(.Clf OR APPLICANT IS T(:3 FIELD LOCATE AND f::ONF:rR''1 THE
ELEVATION AND POSITION OF :E::Wi:::R STUB PRIOR 1:O1 T'O ANY OTHER
EXCAVATION
AVA1:i.A:Fi..E Al THE COUNTY
TO LOCATE BURIED (;A.(:ri...E.:i.', GAS PIPING, WATER LINES, ECT.:
CAt...t... BEFORE ; YOu DIG (456-8000)
SEWER STUBS ARE: TO BECHECKED PRIORTO CONNECTION TOINSURE
THAT THEY ARE CLEAR AND 1NOBSTr;I.J(: 11 1,10 THE SEWER MAI
rt•**m;*3*3*• :. CALL FOR INSPECTION F'i..:(:::T:i:fiN 1 <'1:%iR TO COVER )*•.) 3*)*3*)*ai•*:•3*
)* .' )* 3* Mfr• :. )* )E• 3* 24 HOUR NOTICE REQUIRED )* k• )* v* * :k : * ,k a
..... .
:�* �n: k• )* k k• H• )* 3r: )* )* )* )i• •A: )r v* �: ;•*• )* )<..p .i% •'r: i* )¢ i*• ri• )* k 'h: 3* )* THANK '{' I: { .- t x i* k• )i•ar.:h 'i* *• p;• ri• )* :H: k• * )* )*• W 'n: k• * v* )c ” 3* i* •:R• " :;1.
VENDOR
CODE
NAME
SPOKANE COUNTY. PAYMENT VOUCHER
MISC
H & S CONS FRUCT I0
ADDRESS 11817 EAST VALLEYWAY AVE.
SPOKM , WA 99'
AUDITORS STAMP
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the services
renderecOr the labor performed as described herein or contracted
fnc, and that the claim is a just, due and unpaid obligation, and that
I'am authorized to authenticate and certify to said claim.
SIGNED
TITLE
DATE
TITLE FILE ADMINISTRATE'
DATE 2/19/91
CHAIRMAN
MEMBER
MEMBER
ACCOUNT DISTRIBUTION, ORIGINATING ENTITY (ALL VOUCHER TYPES)
•
1099 REQ'D ID#
LINE
NO.
VENDOR
INVOICE NUMBER
FUND
AGENCY
ORGAN-
RATION
ACT
OBJ
SUB
OBJ
REV
SOURCE
SUB
REV
JOB
NUMBER
REPT
CATEG
BS
ACCT
DESCRIPTION
AMOUNT
.J1328
4241
DETAIL
DESCRIPTION
1 REFUND ON 91001328 FOR 110 NORTH FARR ROAD, WORK NOT DONE n,-2
1, ned
certthe
underrsi a allt do of hereby
yp y perjury
TOTAL
COPY OF PERMIT ATTACHEDD
that sufficient funds have been
$50.00 X 80% = $40.00
budgeted for this claim, the ma-
terials have been furnished, ser-
vices rendered or labor performed
as described herein or contracted
for, that the claim is a just, due
and unpaid obligation against
Spokane County or fund agency
TRAVEL CERTIFICATION
I hereby certify under penalty of perjury
that this is a true and correct claim for
necessary expenses incurred by me and
that no payment has been received by me
on account thereof.
SIGNED
indicated above, that I am autho-
rized to authenticate and certify
TITLE
INTRA -GOVERNMENTAL VOUCHER
to said claim.
DATE
FUND
AGENCY
ORGAN-
RATION
SUB
ORG
SELLERS
ACTIVITY
ACCOUNT
REVENUE
SOURCE
SUBOFFSET
REv
SRC
DISTRIBUTION
JOB NUMBER
RPL
CATEG.
RECEIVABLES
ACCOUNT_CE
-
EXAMINED and ALLOWED
T
DATE 19
-,_-IFICATION
•:-.7\--------
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the services
renderecOr the labor performed as described herein or contracted
fnc, and that the claim is a just, due and unpaid obligation, and that
I'am authorized to authenticate and certify to said claim.
SIGNED
TITLE
DATE
TITLE FILE ADMINISTRATE'
DATE 2/19/91
CHAIRMAN
MEMBER
MEMBER