1991, 01-24 Permit: 90006266 Sewer - A_t i. !rrri.r
SPOKANE COUNTTDEPARTMENT 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 —.
r:t: O ?t••F.....i NUMBER= 90 0," :'i66 DATE= 01 /. 4/9" PAGE== 01
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,t t• ,_., ..,, 1;,,i 7 41 1:;:,C 1•:.t,.It. 2254 .,.i
ADDRESS= SPOKANE WA 99216 __
PERMIT USE= SEWER CONNECTION — 8801 ,
PLATO= : : 09 5 PLAT aa"? = Y :. , tirE
DE ! . SUBURBAN i CR E ADD ,
.
BLOCK= i OT= 3 ZONE= t'x:';E..B DJE T
AREA= 00000000 FiA= F WIDTH= DEPTH= R/W=
0 OF "#... '1 G,:: ? :k: DWELLINGS=
OWNER— OTA, SHIRLEY PHONE=
STREET= 721 ,.•:• I::.S'•.t.:I...?::.E•i RD
99216 '..
ADDRESS=ti::a SPOKANEWA
CONTACT NA{'•E:=: DONNA c:is:it.iRCHA:I.i`'-?E: F`HON F. NUM BE•,::. 509 :455
BUILDING
, - • Y S: i :rt <, : FRONT= ;y ? : - 1 . NA RIGHT= NA REAR= `
..
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CONTRACTOR= 1.:!..i+..i?';i.:H(:::.i,l••;E CONSTRUCTION PHONE= 509 '32c 5455
STREET= i6402 ?... L i••tt...i...l:..T WY! r'
ADDRESS= VERADALE WA 99037 ,
ITEM "'}.. tis.l. t - I;-j QUANTITY -',::.E r't+'?(. J.,li@ !
PROCESSING FEE „ „
SEWER 1.:ONN`f.: C f 'i 4C ,00
************************K****** .... .. '11:3:'N::`+:'P:'t':'A:i+i+:.jl.'F:-il.o.},:'jl'j+:-jl:'}+:*)l'**:-"•:'}!;
r r••• •v :•,t:::
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PAYMENT :.:!t I i... E''.:?::. ! .?. I x PAYMENT (MOUNT
TOTAL JlE: .00 TOTAL PAID=
. +. . }` ,00
PERMIT TYPE t..E AMOUNT NT Aa:?;..+Lsr'+'-• 1 't' D '+M .i NT of I'NG
SEWER C ?::.i'•.t•`?.!. ? :...,.
50.00 50.00 1 , 00
PROCESSED t;#Bp:#i` • :.i i I?....I.I::. ,.`.•.I"I r--c ? t t.J
PRINTED BY : !I I I....I.?'.. ::i}..E A ? t i_!
c?.:.Wf:F STUB AS—BU.E.E:?... , INFORMATION IS AVAILABLE i ? ? ..E::. COUNTY
UTILITIES 1.?t...l A I': I ?"t,..:N I _A456-3604)
CONTRACTOR OR APPLICANT .1: ?._ FIELD LOCATE AND (" 'j i+:•I ;°Ewi THE
ELEVATION i' POSITION , - SEWER h -R C -l ; PRIOR I ; OTHER
EXCAVATION
.Ij`i
! } ,LOCATE i.#i..JI'tIr-t! CABLE,1tE.. ..ta' .I. 'ING : WAiE.;l, 1LINES, Ei'T,
CALL BEFORE YOU t`! , , (456-5000)
... .. '.-}0.i
SEWER STUBS r'R =:E O BE CHECKED CLEAR
PRIOR
. EO i CONNECTION
INSURE
THAT , � ARE r ? a ^f ' ^# 1 -ft1 � _ ? _ , F ; "' .
5* HNx R* z dx CALL tO INSPECTION ? tE �fCOVER� .hu. : 3 E k}
»'*3E•}£•3i••»'it 3r'if• ::::.:r HOUR NOTICE REQUIRED *#'ti•:r3 }:ri.•.}:
i 3 l3i ( .t ) 456-3604
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Cf.
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 OF OCCUPANCY 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:__________