1991, 11-27 Permit: 91007928 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 mcompile vum /uv o u istrue correct, and authorize Spokane County m proceed with processing. Inaddition, IREQUIREMENTS/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= 91007928 I%%UED PERMIT DATE= 11 /27/91 PAGE= 01
**************************** PERMIT INFORMATION ****************************
SITE %TREET= 17022 E 4TH AVE PARCELO= 2454i -9O78
ADDRE%%= GREENACRE% WA 99016
PERMIT U%E= SEWER CONNECTION - GOOD SAMARITAN (91 -%54)
*** SEE NOTE ***
P = 999999 PLAT NAM E RANG � -'
B = ZONE=- UR-7
' AREA= 00000080 F/A= F WIDT�= DEPTH= R/W= 50
:3: OF BLDC;%= ER DIST
OWNER= MALLICOT , PAT PHONE= 509 922 8352
` STREET= 17022 E 4TH AVE
ADDRESS= VERADALE WA 99037
CONTACT NAME= JOHN MALLICOAT PHONE NUMBER=
BUILDING SETBACKS : FRONT= N/A LEFT= N/A RIGHT= N/A REAR= N/A
***************************** SEWER PERMIT *********************** ******
CONTRACTOR= OWNER PHONE=
ITEM DESCRIPTION QUANTITY FEE AMOUNT
-------------------_----- -------- ----------
PROCESSING FEE Y 10 00
SEWER CONNECTION i 4O^ O0
******************************* PAYMENT SUMMARY ****************************
PAYMENT DATE RECEIPTO PAYMENT AMOUNT
11 /27/91 9090 50 ()0
TOTAL DUE=DUE= .00 TOTAL PAID= 50.00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
--------------- ------------- ------------ -----�-------
EWE:R PERMIT 50.00 50.00 .00 -
---------~--- ------------ ------------- _
50.00 50.00 .00
PROCESSED BY : DOMITROVICH, ROBIN
PRINTED BY,: 'DOMITROVICH ROBIN
� -- - `-
SEWER STUB A%-BUILT INFORMATION I% AVAILABLE AT THE COUNTY
UTILITIES DEPARTMENT (456-3604)
CONTRACTOR OR APPLICANT IS TO FIELD LOCATE AND CONFIRM THE
ELEVATION AND PO%ITION OF SEWERSTUB PRIOR TO ANY OTHER
EXCAVATION
TO LOCATE BURIFD CABPIWATE� LI�E% ECT
CALL BEFORE YG� DI� (451-8O00)
%EWER %TUB% ARE TO BE CHECKED PRIOR TO CONNECTION TO INSURE
THAT THEY ARE: CLEAR AHD� UNOBSTRUCTED TO THE SEWER MAIN ''
********* CALL FONSPE ON^ IOR TO COVER **********
********* 24 HOUR NOTICE REQUIRED **********
********* 456-3604 ' ^ ********** , ,"`' ' r . '~'
******************************* THANK YOU *********************************
s .
` `
SPECIAL CONDITION CHECKLIST
Project
Address: Project# Use:
Dept: Date: Condition: !nit: 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 OFOCCUPANCY 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: .— _.— —
CODE ENFORCEMENT DIVISION
WEST 1303 BROADWAY•SPOKANE,WASHINGTON 99260-0550•,5001 450-3675
FAX(509)456-4703