1991, 02-20 Permit App: 91000604 Sewer 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, 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
APPLICATION
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SITE STREET= 3120 S RAYMOND .. 295440906
CHESTERPLAT4= 000376 PLAT NAME=SPOI<ANE WA 99206
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CONTACT NAME= DONNA COURCHAINF RE...INE NUMBER= 709 9?4 745
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STREET= 16402 F
ITEM DESCRIPTION QUANTITY AriiMNT ,
SEWER CONNECTION
40 , 00
PERMIT TYPE FEE AMOUNT AOUNT RT.f. AMOUNT ni,rn.j
50,00 , 00 50 ,00
iUL...I.t:. SUATTO
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UTILITIES DEPARTMENT (456-3604)
- ELEVATION AND POSITION OF SEWER FRiOR
TO LOCATE BURIED UABLE : LAN
CALL BEFORE YOU DIU, ( 456-8000)
SEWER R ... _ : ..,. fU BE ii E'•
RIOR
THAT THEY ARF fli.17.'AR AND HNOBETRHflTFD TO -C. E :72FNER MAIN
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i..f;i:i INSPECTION COVER a .. . . .... .. ..
1,•' •In ti:41' •1(. .t!f . 3-� ., .,+,1 **,.**3,:-,g..).:..**.),:-
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SPECIAL CONDITION CHECKLIST
Project
Address: Project# _Use: _
Dept: Date: Condition: Init: Appr:
(in) (out)
Dept.of Bldgs.
Special Insp.Final Report
Hydrant( )
Lock Box
Engineer's_ _ RID/CRP
Easements
Road Plans/Improvements
Bonds — --
Planning Bonds
Utilities — Double Plumbing
—
ULID --- — — —
Other__
*******************************THIS SPACE FOR COMMERCIAL PLANS TRACKING,CERTIFICATE OF OCCUPANCY ONLY******************************
Date received for C/O processing: _ _ Plans pulled for final processing:
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: _-------___-_--------------- -_-__--