1991, 04-10 Permit App: 91001724 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
,.. .t { ::.t NUMBER= 91 ..'J+:1 f %4 APPLICATION
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SPOKANE WA 99206
,LL- SEWER CONNECTION .... NORTH H I:OI !
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... AMOUNT
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SEWER- CONNECTION
PERMIT. TYPE tAMOUNT AMOUNT AMOUNT Hy
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_ JULIE
_.. ESTUB— AS—BUILT INFORMATION f AVAILABLE A.t•. THE COUNTY _..
(.11-:...._ 1-1:ES; t;:P iftl { {v{t. N ; r 456_.360A'.;:
APPLICANTCONTRACTOR OR
ELEVATION AND
POSITION t ? .
- EXCAVATION
TO LOCATE BURIED rPIPING, WATER
LINES',
: "i : BEFORE YOU DIG
SEWER STUBS ({ty:E TO BE CHECKEDPRIOR ..z.:. CONNECTION TO T i.- •i,i r.:
THAT THEY ARE r r i..:tiij+ A£1T) UNOBSTRUCTED
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t( TEr ; THE SEWER " f-TN .. -
iekiRt3NY CALL + ca + ,. :Ei-rFN ad{ .CA, tfCOVER **********
-1!-*9'i i?'*P`."?;-9!=!+. 24 HOUR N-. y« 'iREQUIRED
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- 456-3604
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***********Ka******************* THANK 7 l }:•j'is }E)i 1S CF:'1:1.1t 31 9,'-1.1!1!•'P:) jt it 9t 3'P Jt 3!•ll'A• t!.! 1
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J B ADDRESS:
SUBDIVISION: 'D-q S`/ t/ 6 ���S LOT: l BLOCK: 1
OWNER: 4) h--11
1 14 PHONE:
ADDRESS: J
CONTRACTOR: 14 r' PHONE:
ADDRESS:
LICENSE #:
INSPECTION DATE: _/
TYPE OF OCCUPANCY:
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