1991, 04-15 Permit App: 91001803 Sewer SPOKANE COUNTY a DEPARTMENT OF BUILDINGS
W.130.E BROADWAY AVENUE
SPOKANE, WASHINGTON 99260
(509)456-3675
I certify that I have examined this permit/application,state that the information co Itained 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 a,.7lition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE
provisions included herein and agree to comply with same.All provisions of laws a,d 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 subse. +ent 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= 91001003 APPLICATION DATE= 04/1591 PAGE= 01
)i•M*)r** THIS I,"' NOT A PERMIT ) 3J ) ;t
PENALTIES WILL B : ASSESSED FOR COMMENCINGWORK WITHOI..1..I A PERMIT
SITE S1Fll ' . 1406 PROGRESS RD PAF '( _„ -
23544-1602
ADDRESS= VERADALE WA 99037
PERMIT USE= SEWER CONNECTION -•• DRY 1...I:NE ONLY
N* SEE E N OTE: *);.);.
FLATt- 002751 PLAT NAME= VERA
B1...(I(:'k;:::: 107 LOT= ;,11NE-::= UNK DIST;1:: F:.
00000000 F r`Fi= F WIDTH= DEPTH= F,:/W=::
tFB _DG ; 4: T4ELII " E: WATER DIET
OWNER:::: l•1c:lur.,:Fl I N PHONE=STREET= 1406 �� PROGRESS tR D
ADDRESS::: VERADALE WA 99037
CONTACT NFME _ DONNA SFcoURCd� I �EPHONENUMBER= 9 924 548=
{�
BUILDING SETBACKS : FRONT== NA LEFT= NA RIGHT= NA REAR:::: NA
?) tHP) i *) k PPPPaA1RhiR { t P) * {) riSEWER pEFMFt h"k x*34RP
k kk hhPk 4 NR) Ai * k* k t h P
CONTRACTOR= COURCHAINE CONSTRUCTION PHONE= 509 924 5425
STREET= 16402 F:: V nl...I...F::v'IIAY
ADDRESS= VERADALE WA 99037
ITEM DESCRIPTION is UANTIIY FEE AMOUNT
PROCESSING FEE10.00
SEWER CONNECTION 1 40 .00
PERMIT TYPE FEE E AMOUNT AMOUNT PAID AMOUNT OWING
_ .:i. „oo 0
l::.(R1E:.F�. P I:::Fit�tl. t .?t�.,t:+(:r
5,t ,r 50.00
PROCESSED}1..:D I;Y : JULIE SHATTI't
PRINTED BY : JULIE SHATTO
SEWER STUB AS—BUILT INFF'CIRMATION. Is AVAILABLE AT THE COUNTY
UTILITIES DEPARTMENT (456-3604)
CONTRACTOR OR APPLICANT IS TO FIELD LOCATE AND CONFIRM THE
ELEVATION AND POSITION ITI:(:IrJ OF= SEWER STUB PRIOR TO f'A±t'31 OTHER
EXCAVATION
TO LOCATE E?URI:E::I) C'::AEi...i:::S, GAS PIPING, WATER LINES, 1:::(::'T' .:
CA1...L. BEFORE YOU DIG (.456.._0000)
SEWER STUBS ARE TO BE CHECKED "''e IOP TO c..CI•.;; :.., i 1 c URE::
THAT THEY ARE C;L...E:AR'. -AND; UNOBSTRUCTED TO THE SEWER MAIN
)t')l P:T:)l)l '*P CALL FOR INSPECTION PRIOR TO COVER Ft: *•>•:,i'****�:'x--;;-
)l)l N:)l)l !)l )l :,:y 4 HOUR NOTICE qREQUIRED ')l A'iR')t M-)l)l ri N'
*. . .:: *. ****3...'3?'*'h•)t•!••ir is it)tAAAAA)l*•h.•)k THANK YOU iL•i?•AA•tNP:)t)t)t•iF)!•R•ilA)t*AAAA)l)t)l i?•iY rA•irA:a•ir•r
SPECIAL CONDITION CHECKLIST
Project
Address: - — _ _ Project#_ ___ Use:
Dept: Date: Condition: Init: Appr:
(in) (out)
Dept.of Bldgs.
Special Insp.Final Report
_�_ Hydrant( )
-_-- Lock Box
fl (- 1 L
Engineer's- RID/CRP
Easements_
Road Planshmprouoments• ..
Bonds
Planning - . Bonds
Utilities_ ____` Double Plumbin
ULID . ... .. ..
Other_—
-*****************"*""Y.I.!.I;”:,--i'"IiTHOSSPACEFORCOMMERCIAL:PLANSTRACKINIG'CERTIFtCA>~EOFOCCUPANCYONLY"q,`*"***********************"'
Date teceivedlo 'C/t? ;. ,4 ; Pians putted:tor final processing._ 'ff"';
Temporary C/O issued:,._..__..___ - Certificate of Occupancy issued:
Office file review by: __ _ __ . Date:
Filed insp finaled by:____ _.____ _ _ _. Date:
Ninety days after C/O issuance:
Owner/contractor called regarding the return of plans: Date:
Plans returned: -__ _. -___.__-- -- ---------- __-.Received by:_-_.-____________-_. __._--------------__--_-
No response from owner/contractor-plans destroyed:- ---_ __-- -__-- ---------_--------___.______-------------__---------
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