1992, 09-04 Permit: 92007276 SewerSPOKANECOUNTY 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, 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= 92007276
ISSUED PERMIT DATE= 09/04/92 PAGE= 01
**************************** PERMIT INFORMATION ****************************
SITE STREET= 2625 S HOUK CT PARCEL`= 45273.2906
ADDRESS= SPOKANE WA 99216
PERMIT USE= SEWER CONNECTION - HILLCREST (92S-886)
*** SEE NOTE ***
PLATT= 001230 PLAT NAME= HILLCREST ACRES 7TH ADI)
BLOCK= 2 LOT= 6 ZONE= SFR DIST:= F
AREA= 00000000 F/A= F WIDTH= DEPTH= R/W=
A.
OF BLDGS= DWELLINGS= 1 WATER DIST =
OWNER= TRIMBLE, GARTH PHONE= 509 927 0430
STREET= 2621 S HOUK CT
ADDRESS= SPOKANE WA 99216
CONTACT NAME= COURCHAINE EXCAVATION PHONE NUMBER= 509 924 5485
BUILDING SETBACKS: FRONT= N/A LEFT= N/A RIGHT= N/A REAR= N/A
***************************** SEWER PERMIT ******************************
CONTRACTOR= COURCHAINE CONSTRUCTION
STREET= 16402 E VALLEYWAY
ADDRESS= VERADALE WA 99037
ITEM DESCRIPTION
PROCESSING FEE
SEWER CONNECTION
*******************************
PHONE= 509 924 5485
QUANTITY FEE AMOUNT
Y
5
PAYMENT SUMMARY
50.00
40.00
****************************
PAYMENT DATE RECEIPT* PAYMENT AMOUNT
09/04/92 7389 50.00
TOTAL DUE= .00 TOTAL PAID= 50.00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
SEWER PERMIT 50.00
50.00
50.00 .00
50.00 .00
PROCESSED BY: DOMITROVICH, ROBIN
PRINTEI) BY: DOMITROVICH, ROBIN
SEWER STUB AS -BUILT INFORMATION IS AVAILABLE AT THE COUNTY
UTILITIES DEPARTMENT (456-3604)
CONTRACTOR OR APPLICANT IS TC) 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 TC) CONNECTION TO INSURE
THAT THEY ARE CLEAR AND UNOBSTRUCTED TO THE SEWER MAIN
********* CALL FOR INSPECTION PRIOR TO COVER **********
********* 24 HOUR NOTICE REQUIRED **********
********* 456-3604 **********
******************************** THANK YOU *********************************
SPOKANE COUNTY', PAYMENT VOUCHER NUMBER 132011
VENDOR REFUND ,I' DATE
11/4/92
CODE
v
z',:mkt' - / { �r� AGENCY CODE ENFORCEMENT
COURCNAINE ODNSIRUCTION t' ti,M,iuiy s.j r - NAME
NAME ,, et''' ,,! i r�i, ?n.• a�',r
. `..I1` ) ,44; r� roti..: AUDITORS STAMP
16402 EAST VALLEYWAY `' ' L` '
ADDRESS a
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SPOKANE, WA 99206 i , �;H�---"- �� !.r! I ,'
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ACCOUNT DISTRIBUTION,ORIGINATING ENTITY(ALL VOUCHER TYPES) 0 1099 REQ'D ID#
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UE ,z- VEDOR 1. _,,.. ,.,..._. _•. .,,-,',••, .ORG _. . . .�, ,, .SUBgREK v �$1B� .rf .�,JO8 = ���EPT � r j. + . ..,
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NO. , INVOICNUMBER . - - , . ,; ZAION,s ? .,, .:, .QB .SOU.RC ,.REV«10N.UM.BE. >'C4- Gd�ti>. 99J r :�m�� . r;..u.�., - •>; � . r ���., .wX}xs�.• m :aa .<.',...w:,,s
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1 406 030 0008 16.00 2210 02 -
2 401 436 0000 4240 64.00
3 406 030 0008 2210 03 56.00
DETAIL DESCRIPTION '
1 & 2 PERMIT 92-008690 FOR 3026 SOUTH RAYMOND CIRCLE AND PERMIT #92-0092-007276 I, the t fe underundersigned penalty operjury
do hereby TOTAL 136.00
FOR 2621 SOUTH HOUK CT AS FOLLOWS: cthat sufficient funds have been
$10.00 X 80% = 8.00 X 2 = $ 16.00 budgeted 'for this claim, the ma- TRAVEL CERTIFICATION -
$40.00 X 100% = 32.00 X 2 = 64.00 terials have been furnished, ser- I hereby certify under penalty of perjury
PERMIT #92-007277 FOR 2621 SOUTH HOLM CT AN) #92-008597 RR 12818 EAST vices rendered or labor performed that this is a true and correct claim for
231D AVE AS j=i0tl.Qr1S: r
as described herein or contracted necessary expenses incurred by me and
ford that the claim is a just,-due that no payment has been received by me
$35.00 X 80% = 28.00 X 2 = $56.00and unpaid obligation against on account thereof. .
PER COPIES OF PERMITS AND LEI IIR ATTACHED. Spokane County or fund agency SIGNED
indicated above, that I am autho TITLE
rized to authenticate and certify •
INTRA-GOVERNMENTAL VOUCHER to said claim: DATE
SELLERS ACCOUNT DISTRIBUTION EXAMINED and ALLOWED
ct tr ;,.`, ANt `SUB fix:: & REVENUE•• REV `r=4JOBpNUM ER xjr. i'RPTe ..nscEivABALEsr` -
FUND AGENCY..RATION 'ORG ACTIVITY -t.sOURCE,v'.sqc,.-.-:..V., h, r „sCATEG. .. ACcoUrtr�--, = DATE 19
CERTIFICATION
~ 1 CHAIRMAN
SIGNED \,
SELLER CERTIFICATION
FICE ADMINISTRATOR
I,hereby certify that the materials have been furnished,the services SIGNED TIT MEMBER
rendered or the labor performed as described herein or contracted TITLE 11/4/92for,and that the claim is a just,due and unpaid obligation,and that DATE DATE MEMBER
I am authorized to authenticate and certify to said claim.
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