1991, 04-18 Permit: 91001913 Sewer SPOKANE COUNTY DEPARTMENT OF BUILDINGS
W. 1303 BROADWAY AVENUE
SPOKANE,WASHINGTON 99260
(509)456-3675
/oom/vmut/oavooxammoum/opmm/vunnnvanon.mmomanhomm,munopzonuu/"ommnonuovumntou»vmounnvagentmoomv0000mpermit/application is true
and correcand authorize SkCounty to proceed withnmvossmo In additionI 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 z///e/(7/
OWNER OR AGENT
\-4 -61' A DATE
PROJECT NUMBER= 91001913 I%%UED PERMIT DATE= 04/i8/9i PAGE= Oi
**************************** PERMIT INFORMATION ****************************
%ITE
STREET= 2825 % %KIPWORTH RD PARCELO= 28543-4117
ADDRESS= SPOKANE WA 99206
PERMIT USE= %EWER CONNECTION FOR KOKOMO TOWN%ITE
*** SEE NOTE ***
PLATO= 001393 PLAT NAME= KOKOMO TOWN%ITE
BLOCK= 4i LOT= i3 ZONE= UR 3. 5 DI%T,;;:=
AREA= F/A= WIDTH= DEPTH= R/W=
4 OF BLDG%= DWELLING WATER DIET =
OWNER= %TOKKE , BEN PHONE= 509 926 3057
STREET= 2825 % %KIPWORTH RD
ADDRESS= %POKANE WA 99206
CONTACT NAME= HOLTEN BROTHER% PHONE NUMBER= 5O9 926 9087
BUILDING %ETBACK% : FRONT= NA LEFT= NA RIGHT= NA REAR= NA
***************************** %EWER PERMIT ******************************
CONTRACT R= HOLTEN BROTHERS PHONE= 509 926 6978
STREET= ii704 E 8TH AVE
ADDRE%%= %POKANE WA 99206
ITEM DE%CRIPTION QUANTITY FEE AMOUNT
------------------------- -------- ----------
PROCE%%IN6 FEE
SEWER CONNECTION i 40 . 00
*************** ************** PAYMENT %UMMARY ****************************
PAYMENT DATE RECEIPT-4 PAYMENT AMOUNT
04/18/91 2158 50 .00
TOTAL DUE-DUE= . 00 TOTAL PAID= 50.00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
--------- ---- ------------- ------------ -----------
%EWER PERMIT 50.00 50 .00 .00
------------- ------------ -------------
5O.00 50 .00 .00
PROCE%%ED BY : JOHN LAR%ON
PRINTED BY : JOHN LAR%ON
SEWER"STUB A%-BUILT INFORMATION I% AVAILABLE AT THE COUNTY
UTILITIES DEPARTMENT ( 456-36O4)
CONTRACTOR OR APPLICANT I% TO FIELD LOCATE AND CONFIRM THE
ELEVATION AND PG%ITION OF SEWER %TUS PRIOR TO ANY OTHER
EXCAVATION
TO LOCATE BURIED CABLES , GAS PIPING, WATER LINES , ECT ,
CALL BEFORE YOU DIG (456-8000)
SEWER %TUB% ARE TO BE CHECKED PRIOR TO CONNECTION TO INSURE
THAT THEY ARE CLEAR AND UNOBSTRUCTED TO THE SEWER MAIN
********* CALL FOR IN%PECTION PRIOR TO COVER **********
********* 24 HOUR NOTICE REQUIRED **********
***** *** 456-3604 **********
******************************** THANK YOU *********************************
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 OFOCCUPANCY 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:____
/2 z3
JOB ADDRESS: 5 (2.B aS S I 1 JP(t J ng T ��-�y� - e///9
SUBDIVISION: LOT: /?yiiYBLOCK: y/
�
OWNER: 3EN _STOKkT PHONE: gc(1 `30,E 7
ADDRESS: „5 J7l
CONTRACTOR: }-�(�L�E)t) 07-1/t es PHONE: 9a(.0 "90,
ADDRESS: E// 70/4 8147190,
LICENSE # : H )LTF"l / 95L-r7
INSPECTION DATE: -
TYPE OF OCCUPANCY: