1991, 05-09 Permit App: 91002443 SewerSPOKANE COUNTY DEPNTMENT 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, oras a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
Project
Address:
Dept:
Ta
SPECIAL CONDITION CHECKLIST
Dept. of Bldgs.
Date:
Engineer's
Planning
Utilities
Other
Condition:
Project # Use:
Special Insp. Final Report
Hydrant ( ')
Lock ciox
RID/CRP
Easements
Road Plans/Improvements
Bonds
Bonds
Double Plumbing
ULID
!nit:
(in)
Appr:
(out)
TH IS SPACE FOR COMMERCIAL PLANS TRACKI NG, CERTIFICATE OF OCCUPANCY ONL=Y
Date received for 0/0 processing:, Plans pulled for final processing -
Temporary C/O issued' Certificate of Occupancy issued
Office file review by: Date:
Filed insp finaled b : Date:
Ninety days after 0/0 issuance:
Owner/contractor called regarding the return of plans: Date'
Plans returned: Received by
No response from owner/contractor - plans destroyed',
JOB ADDRESS: a() 1 1(1 2-74t
SUBDIVISION: al 511( -161 a LOT:
OWNER: ,4 Aa.ina PHONE:
ADDRESS: 0 ,, ap C�
CONTRACTOR: -A'M `0_2) PHONE: LiLic- /g? �1
ADDRESS: 5603_
6i •JLJt9
LICENSE #:' /��'�"y -�! 130' i1
0 19
BLOCK:
INSPECTION DATE:
TYPE OF OCCUPANCY: