1992, 11-30 Permit App: 92010453 Plumbing Fixturesfo
PLUMBING PERMIT APPLICATION FORM
Information Worksheet
ESS: o
JOB STREET ADDRESS:
CITYISTATEOP:— C,-�iqc Cl 20C, PARCEL NUMBER:
OWNER:-- k vy, nnecS r PHONV NUMB
MAILING ADDRESS!
• (Street) -D- (CItylstate) (23p)��
CONTRACTOR:-
C(O LICENSE NUMBFJ:L- yn�
P INUMB
HON
7> V,
MAILING ADDRESS: "F- c-
(CitylSt
tate) (ZIP)
(Street) (cityls 8)
PLUMBING WORKSHFF I IFEESCHEDULE
NOTE'. MINIMUM PERMIT FEE IS $35-00
SIGNATU
cr%Mr-12mes rf%ffnfir n;%f;o;nn of R11HAinne
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 permit/application is true
and correct, and authorize Spokane County to proceed with processing. In addition; l 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 construeb 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 C APPLICATION
OWNER OR AGENT,' —r? CG )t. {t, Cf. L (-C—A.Q DATE
f:
PROJECT NUMBER- 92t7it)453 ISSUED PERMIT DA'T'E"= ii/30/92 PAGE"::: 01
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.SITE :: i RADDR(E::E::T' .: iii .'',:3 E PONDEROSA RO ifs DR E� ARCE: L 44042.202R
SS- BROKANE WA 99206
PERMTT USE- (::;)PI...LLiiT:ING 11.;("TURF;:,
PL..AT.•;;::: 001743 PLAT NrtME:r MYRON ESTATES NO 8
BLOCK- LOT= ?B ONE:::: !JR -'•3: `_"> ,•D I S T O- E:
AF+:I::A:::: F•/A= F W):•D'T'H- I71=.F'TH-- F,iW�= 6( -*)0 Ili BLDGS= 1 0 DWELLINGS -1• WATER ):LST
OWNER- S i:;i•i1 i:i:ST E.: R , ,:CCIT" T' PHONE- 509 927 2436
STREET- lii"131 E PONDEROSA DR
ADHESION > F' C! I(A % WA 99 206
GON T•i 1 T NAME- AQUA MECHANICAL PHONE tJtJr'ITff:E•;= 509 487
Pi,.):ILDiHK NE TI.AC ,';: FRONT= ('A LEFT= NA RIGHT= NA REAR= NA
r: •k• ii )i: h: ii k: ii i. c n ;i ;�; ;�: if J; �,::�• )i di" h• }i• 3i !•} h; it• .J� )t )i• '• ")i• dt' ie ii• ri• 3i• �i• k• #' ik 9k # ii• tF ")@ �:• # hi it •)i 3i• )r if• n :r. t, J,' >
C:OMT R ACT. Cil=s::.: t:.)l:: UA L'iE: (:;!•i/ ART T. [.".AIRE R RG PHONE= 509 483 0635
S T•RE::E T :: 0407 E EUCLID AVE:
i" �I)T)E•.'I`,'f,C:::: ,.SI-'(JI\Ai:dE WA 99207
ITEM D"r...i::RIPT'a i:' i ¢ f;,i(Ja`,N.I..I'_I.,f. FEE /')i''iOUN'T'
— ......
PROCENSTMG FEE Y 25.00
T0TLFJ,',' 6100
BATH TUBE y i 6.00
9t # it #� # if i4 # fi ii ')t )t 9¢ tt• j; # ii iE # # fi:' tF ii x ;f ;{ J( It h h }(. E' fi % T
SUMMARY
� � H �f H ti �(� }i ii ii it )4 M # # 3i ik 1E !E � ii � # N r: #• N
,r
PAYMENT DATf::RI C:Ft1�` O 1='fi`r`lii:NT ratiC1l1i;!!7
11/30/92 732 43.00
TOT'AL DUE= .f)�7'' "TLJTr�I._ PAID - 41-3-500'
PERMIT TYPE
'PLUMBING PERMIT
FEE AMOUNT
r
.00
-------------
43.00
PROCESSED BY: WENDEL, GLORIA
E''R):r•lTi:::t1 BY: WEtlf:iE l._, GLORIA
;i• #• #• # •N:" �i �:• r: ii •r: ii :K• i�: Ai• •r: •hi Jt• ii• ii• ir: �: )i. i�; ;i"si• :�,; ii• ;,i :a 3i• 3+: i4
AMOUNT E'r'iID AMOUNT..AMOUNT.._.._ OWING
43.00 _.... 00 .
.-........_...,..........__. --------------
43.00
--..._ ....................__— . - --
4 3 . 0 0 .00
THANiC YOU
AM PEC"HANICAL
PLUMB'NG, HEATING, & AIR CONDITIONING
East 2407 Euclid • Spokane, WA 99207 • (509) 487-0103
December 2, 1992
Please see enclosed copy of permit92010453, we are
requesting refund as homeowner took out a permit for
plumbing.
Sincerely,
Leann Gilmore
Office Manager
t
--
�;NETW0RKI
2210 103
®ISN
1 10M REFW ON P6*ff #92-010453 FOR 11123 E. PUCOM PER COPIES
POM & LETTER W DLKTCATE PONT #92-010256 ATTACHED
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the services SIGNED
rendered or the labor performed as described herein or contracted TITLE
for, and that the claim is a just, due and unpaid obligation, and that
I am authorized to authenticate and certify to said claim. DATE
I, the undersigned do hereby
certify under penalty of perjury
that sufficient funds have been
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
indicated above, that I am autho-
rized to authenticate and - certify
to said claim.
CERT'AfICATION
IIfiLJCE AD UNISTRATOR
DATE 12/11/9-2
❑ 1099 REO'D I D #
43.00
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
TITLE
DATE
EXAMINED and ALLOWED
DATE 19
CHAIRMAN
MEMBER
MEMBER