1991, 03-13 Permit App: 91001063 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= 91001063 APPLICATION .( „. .. 03/13/91 PAGE=
* THIS IS: NOT A PERMIT ***f!)tP•
PENALTIES IWIi...(... BE ASSESSED;,':.'E::I? CIF COMMENCING iti(:iI:K: WITHOUT A !'(::Rri.i...I.
SITE ,:> iRE::E::"t..: 512 V E::Et i::'I...E::I:;: RD I::°Fa E{(:::I:::I...4= 22542-1313
ADDRESS= SPOKANE WA 99216
PERMIT I (.iSE= SEWER CONNECTION ...- 800i
K'ib* SEE NOTE 7rii a•
PLAT„:=: 000162 PLAT NAME= Bt";UMANN ' S SUB
BLOCK= LOT= ZONE= (tly,•i•iii T•;:'S O ' F•
AREA= 00000000F/A= W j I:. WIDTH= DEPTH= I::,•'i,:=
•1: (1t•- I;ii».n(.r,J= :y. DWELLINGS= 'I WATER 01S•j ..::
S;
OWNER= I":1:C:i-IA L CIi , ,.i ;i. .t PHONE=
STRE::I:::•T•=:: 512 wVERCLER RD
ADDRESS= SPOKANE WA 99216
CONTACT NAME:::: RON SI._(:IANI PHONE NUMBER,. 509
BUILDING SETBACKS : - : d . NA LEFT= • t RIGH CA rt
is(::,
!!••!t:•u:1t;•N.••i@*n N n r !?N R h N a R•! ! n A R R!?P n ! •;>:• SEWER '`::.:iI"7.. .y....................P..It.:!!••h..:R::F:*-!C•R••P::4••R P:
CONTRACTOR= ALWAYS ACTIVE PHONE=ilvt::..... ..:09 922 0500
(
STREET= PO BOX 141562
ADD�I F IE:S ?:::: SPOKANE IW(, 99214
I'T'I:::i'I DESCRIPTION QUANTITY FEE: r=<i'11,. i..ii`:i»(.
-----
PROCESSING FEE r: 1000
SEWER CONNECTION 40.00
PERMIT T .T... PI.: i-EE AMOUNT AMOUNT PAID AMOUNT OWING
:'•`I::.(xi I::.I': ! I::.t":f'I.I. I 50. 0E) . 00 50.00
50.00 ,00 50.00
PROCESSE:D BY : JULIE SHA•T•'T•0
PRINTED I NlTE D B'Y : -._i(.IL..]:E:: :`.'I•1t i.TC+
SEWER STUB A: ._ LL INFORMATION
IJ ( :MA , _ a 1 i AVAILABLE AT Ti - ( i ?I
UTILITIES ii1-.I'AR1 LIEN t (456-3604 )
CONTRACTOR OR APPLICANT IS TO 11:E::I...1) LOCATE ('I'4(: CONFIRM THE
ELEVATION Fri'' POSITION OF 'E`t'1=R STUB PRIOR TO ANY (:I OTHER
EXCAVATION
TO LOCATE BURIED CABLES, .. .
CALL.. BEFORE ORE f OU DIG (456-8000)
SEWER r . t . ARE TO B . CHECKED ' {. i � TO CONNECTION_ , It INSURE
THAT 1 (FII::.`r' ARE CLEAR AND UNOBSTRUCTED ICJ THE SEWER MAIN
**•!c•»:.jF.il..n,.n..ji. CALL 1••t.t I•': INSPECTION
1 ` : Et ! _ NPRIOR
Rfsi COVER ; ininun, *R
* tTiiP! ii : ! HOUR NOTICE RI , ! ( ?~( ; r*r*anrpi
:Fh3Rt ¢ !n 456-3604
14'At**.jj.:jj..}t:••;!•3t.•'Pi
d4 t,..!!•)F•9;•*}i.t;.J4.jj._7,,ttE..,z..tr.t!.**.A'i»-*)t:'!!'•H•-!t It:n•)i-ii-:@''!h*}i• THANK Y L 17„1 -!!.*.P:9t it*******-t{-****P•jl•!k*!i..jj.ip:i4.jr.*k-*iR•*JE Pr
SPECIAL CONDITION CHECKLIST
Project
Address: Project# Use:
Dept: Date: Condition: Init: Appr:
(in) (out)
Dept.of Bldgs.
Special Insp.Final Report
Hydrant( )
Lock Box
. , "I• j. •
. . . . . . .
Engineer's Fifa/CRP
Easements
Road Plans/Improvements. r.,; . . • :
Bonds
. . ,
• •.. ., • . .
.•
•
•': .
Planning Bonds
. ,
•
Utilities , Double Plumbing
ULID
. , . . .
. . . . . . . . , .
. •
Other
. . .. . . .
• , . . . _ , . . , .
. . . . . . . . .
. . . . .
THIS SPACE FOR COMMERCIALiF?LAiN1,$TFiAOKINFG,CERTIFIOATE OF OCCUPANCY ONLY*t7******"
. . .
Qate received for C/O processing: ,; .• : , ;• 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:
( Of
JOB ADDRESS:
SUBDIVISION: 6D''a S / S /3 LOT: BLOCK:
OWNER: 44�[�� PHONE: 4,64,
ADDRESS: ��✓ /�
CONTRACTOR: V-tr-41
J LZ�/ 1 PHONE:
ADDRESS:
LICENSE #:
INSPECTION DATE:
TYPE OF OCCUPANCY: