1991, 04-24 Permit App: 91002039 Sewer SPOKANE COUNTY DEPARTMENT OF BUILDINGS
I W. 1303 BROADWAY AVENUE
i 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
,r.. ...•,• NUMBER=
:••. :.:•.:.:,. .. _. ... : PAGE=?'':�.�t�?::.•..: 1 IY�.-�i'?�.57::.?.,.... ":}� } '•.'"•.r.ti:.::�.,�t'';! APPLICATION .�3'� ? ?::.'•_ .:�'t!!!� : ?..." ?
Vit.j.j:.p:.jv:;t. THIS I.`. NOT A }'•? R M F_ 1 't *H.**y.
PENALTIES WILL BE ASSESSED~`ED i:•fifi` COMMENCING WORK i,:!I . H ::i i.i• A PERMIT
SITE STREET= 2705 . SKIPWORTH RD
AR. r : 28543-4017ADDRESS= 99206SP K ANSWA
PERMIT U ..= SEWER R } }}NV t } } I EN .... NORTH It:OEl 1.Ji"?O
?"?...h"} ? .,,..... 001393 PLAT ?'Ji..F??1::..... ?'•:_._i?'•.i.J?'?!.! TOWNSITE
BLOCK= 40 LOT= : ;r ZONE= UR3.5 DIST4= F
AREA= 00000000 F/A= }.. icI i „ }_?::- to:% DEPTH= 130 },,::::
,: :., •.., .,...:, DWELLINGS= ':}:,.
0 };.. BLDGS== 7 4: WATER ...... . ....
OWNE:R`•- ':, f t.:}P( ; WA Y N?::. PHONE=:::: ..
STREET= ii'.:? ,`:'E{i,i•�Wi:iE::,..i.FE :_,A:
ADDRESS= ,.P"'i� `!•V�'• WA Vis'' '4;1f_
s
CONTACT
C-•.• AM :v PHONE,O.,.,... ER509 926 0964
BUILDING SETBACKS : FRONT= ('J,A LEFT= N A RIGHT= d t REAR= NA
h;*'p"R iti•ii'K 3Y'lY",?•3+i•br•1t•7{'•1k•il:*'!k 4B:k P.•'!=:R•;t'1t"rt•9k'x: SEWER PERMIT *****K************** *********
CONTRACTOR=(� H =.':•t S CONSTRUCTION PHONE= 509 _. 8964
STR
ET= 11817 E VALLEYWAY AVE
r'DDEn`E::. ;= SPOKANE WA 99206
ITEM E::.r' ;.%E::.t.,t.:RI? ? ... ..r -? QUANTITY FEE AMOUNT
PROCESSING NG EF 1 0 00
EWEE.j:::CONNECTION i 40.00
PERMIT TYPE }..C:.i::. AMOUNT AMOUNT F:'AID AMOUNT ow.E:NG I
SEWER PERMIT 50.00 ,00 50,00
PRIN1ED BY : FORRY; JEFF
:,a!:•r,:•x:•ie 3+:$+i i++i n:a•>z:•.„.:?G:r+i *:r+?:rk 3{•.ji••)ei•i+i;f if”*rr,;:,•y{id•*i+; THANK i}..,;.,i •i}'r'n::+,;i+,:iE:G;G;i;,;.1,;.;,;_;>:..u..i+:*a•:::::e e!?::r:=':?i a:*"x•::'r::::::r:•t:
SPECIAL CONDITION CHECKLIST
Project
Address: Prwject# Use:
Dept: Date: Condition: mit: App/:
(in) (out)
Dept.of Bldgs
SpecialFinal Report
Insp.
*ydran ( )
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 OFOCCUpAwCvOwLv`^~^`^`~^~~`^~^~~~~^^```~~
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 afteC/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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