1991, 12-03 Permit App: 91008349 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
PROJECT NUMBER= 91008349 APPLICATION DATE= 12/03/91 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WIL..I... BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 12206 E VALLEYWAY AVE PARCEL4= 16544-0.302
ADDRESS= SPOKANE WA 99216
PERMIT USE= SEWER CONNECTION -- (91 --S95)
*** SEE NOTE ***
PL.AT4= CONVRT PLAT NAME= CONVERTED CNTY DATA
BLOCK== 125 LOT= ZONE= AGSUB DIST=: F'
AREA= 00000000 F/A= F WIDTH= DEPTH= R/W=
4 OF BLDGS= 1 4 DWELLINGS= 1 WATER DIST =
OWNER= JENSEN MIKE PHONE=
STREET= 12206 E VALLEYWAY AVE
ADDRESS= SPOKANE WA 99216
CONTACT NAME= H & S CONSTRUCTION PHONE NUMBER= 509 926 8964
BUILDING SETBACKS: FRONT= N/A LEFT= N/A RIGHT= N/A REAR= N/A
***************************** SEWER PERMIT ********x•>f •******* •***•x ••x• ****
CONTRACTOR= H & S CONSTRUCTION PHONE= 509 926 8964
STREET= 11817 E VALLEYWAY AVE
ADDRESS- SPOKANE WA 99206
ITEM DESCRIPTION QUANTITY FEE AMOUNT
PROCESSING FEE Y 10.00
SEWER CONNECTION 1 40.00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
SEWER PERMIT 50.00 .00 50.00
50,00 .00 50.00
PROCESSED BY : DOMITROVICH, ROBIN
PRINTED BY : DOMITROVICHI, ROBIN
SEWER STUB AS-BUILT INFORMATION IS AVAILABLE AT THE COUNTY
UTILITIES DEPARTMENT (456-3604)
CONTRACTOR OR APPLICANT IS TO FIELD LOCATE AND CONFIRM THE
ELEVATION AND POSITION OF SEWER STUB PRIOR TO ANY OTHER
EXCAVATION
TO LOCATE BURIED CABLES, GAS PIPING, WATER LINES, ECT.
CALL BEFORE YOU DIG (456-8000)
SEWER STUBS ARE TO BE CHECKED PRIOR TO CONNECTION TO INSURE
THAT THEY ARE CLEAR AND UNOBSTRUCTED TO THE SEWER MAIN
********* CAL..L FOR INSPECTION PRIOR TO COVER **********
********* 24 HOUR NOTICE REQUIRED **********
********* 456-3604 **********
******************************** THANK YOU *********************************
SPECIAL CONDITION CHECKLIST
Project
Address: Project# Use:
Dept: Date; Condition: !nit: Appr:
(in) (out)
Dept.of Bldgs.
Special Insp.Final Report
Hydrant )
Lock Box
'. •:4": CI ,..;! :; ;.
41:-+•f.• •;' 77. A T T7”:
I.' n;:.•• 7 1:11 ft' ;i4 I .; i
" • "'"" " •"""' '"" " ••' . ......
Engineers RID/CRP
•• :kt.Wel`Pts ,74 4 7.4
Road Plans/Improvements ;;', ;;;-i ;;;
Bonds
I Iii
r :: 7", ;•
0,71 V t.'" 4•I
4 '" L._ ;1 :71A . 4, K
; •;. f, •;;
II 1 ii
Planning .. PID:084 "4 1: f
•i-•• (11 f)
'7
:;:i:7, i ! t.y ; j-•;, I 14f:i.
'" H A '"' ..± "" : >4 T: ;
:.3 7.f! 4 .1;
H .;
Utilities Double Plumbing
ULID
i! ): ii :
Other. : '2'; 71 7 i fr; •
11. '
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. .
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0i-1Y *: '",4 ":1II'A A A
—***"******-rr•Irr7** I*11-11.S.:R4c.EREsji;POMMRCTitil...PLANSCFPAC:K{NO;)CEPTIFtCATEICV,OCOIMANCY0,NLYIt"*"**********************"-
;.1II. iT . !; 1111
51..4.,, 4 4. Li T. Y,*4it 4
Date received for C/Oqatecesstfoge I ; ;.;;; ';;;; ;,1:PidiWpulliddrion firfaCprocessingi;
Temporary C/O issuedi• • • 8k141;• ate(§i Occupancy issued:
Office4Reqe.v*wbt 4 'P.-4 4.0:Pi.' bit& Y7 •ti!,
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: