1991, 12-18 Permit: 91004226 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
F p#..)..i.::C t NUMBER= 910 4226 ISSUED ir1 'ii r a;r - 12/1O/91
AI,E= 01
: fi J9r: Ja ...: t : : ` } * tN*} JPERMIT T d r , ?
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, : RAYMOND tR P! hi tn . 32541 -0607
f• w d `r.: - _P ' NCWA 99 '06
i`i..:RifIT. USE= -, -.,ER CONNECTION SOUTH KOKOMO
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!... �..
#.. .!i..._ 000376 PLAT NAME=t CHESTER Li' HEIGHTS
BLOCK= LOT= A .{�),f t::::: H ...;LE:' i T':'-i•''�_:: F.
AREA= r'l:.t t:r".. ?t;!:i s+ t:. :r`l:::: F" WIDTH= 100 ).J# t'`;I••j:;:: 125 Teti `'U,1::. t::l,.;}
I; OF .E#..DG::•.. 1 '\i: DWELLINGS= 2 WATER•{ •i `; ....
OWNER= HAYFIELD, DAVID ,-.: 0 p,.!.^
STREET=REET• ,3219 r.' RAYMOND CIR
ADDRESS= SPOKANE WA 99206 _ ,
CONTACT NAMES:: JAMES NELSEN PHONE NUMBER::: r..!r. 6077
BUILDING SETBACKS : Fist#'t ' ::: ,. LEFT= :t h1i... '.:g
r.: FRONT=i #`�f•:! !'L f�:t RIGHT=' � #\?f•� !'�.f::.�'�i�."" ?�f:.!
}!:it ii•*•},•:•}i•:H:i•:"i+:••.* ***'.Kit•.iii..•j,•.j;•..•jx n•;j•*•ri c E 4 i p= +:'is "'4?"# '.Y# #
....� Sk H••Pi•}li 3k'j!''}t•**.N..A:t!!i.�t..H..H::»:.t,..tl..t!.:q..1!:.tr.H:.H.:p:.n.:t!.:Jy..j!,..Pi
...... .............. .. .. ...
CONTRACTOR= :.f: R r. II CONSTRUCTION PHONE= 509 924 6077
STREET= 10504 E VALLEYWAY AVE
ADDRESS= ��tS " J= WA i�:
: ^
ITEM i DE"' R:i: t . QUANTITY FEE AMOUNT'
PROCESSINGFEE#f• ' 10,00
CONNECTION
SEWER i 40,00
.,!..j!,t,.*'J!•y!;t.•N:t•*'J!•st•;!:"H:'H:ir..i1..i,..N.:x hi i!:H:•}r:*i{..p;*.p..j;..j!. PAYMENT `f.I M M AR. ................•'H'•ii u:H'•*n:H:*ii•'i!::n:'*'*"j!: :'a;'}!: !:
j::'t"MI::.1dT DATE t;,...; E- 1-:... ....A. T 0 P A Y MEN AMOUNT
12/18/91 9531 50 , 00
TOTAL . I:, PAID= 50.00
PAID+ .:. t..I::.t::. AMOUNT AMOUNT (•`ra i..t a r•ir#t_1UN ? OWING
SEWER PERMIT r..,.• 50, 00 .00
50..00 50.00 ,00
'PROCESSED is 'c' : :_toHN LARSON
PRINTED BY : ,}i.?f'iI TR°t:?'4:i:Ci'l, ROBIN
******************************** THANK YOU t„� '}!i'Itr'}k•Ni•}!i 7!r'i{':Hr"Fi'!!:'1!:1!i•Ai'}!i'Pr•}!i.Y'"}!r !r:�(..j{..j{..pt i!!.it,..;!..j:.a:i!t;�j!;j!;:Jj..jj.
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SPECIAL CONDITION CHECKLIST
Project
Address: _.__. ___.-- _ Project#_--
Dept: ', Date: Condition: Init: Appr:
(in) (out)
Dept.of Bldgs.
_ __ Special Insp.Final Report _
------ _-- __ Hydrant( )
Lock Box -- ---- - --
Engineer's-_---. _ - RID/CRP -__-- __-----_-___--
- - — - Easements - ---- - -
_-_ Road Pians/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:_-__