1996, 09-23 Permit App: 96008045 Sewer PROJECT NUMBER= 96008045 APPLICATION DATE= 09/23/96 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 11704 E 6TH AVE PARCEL#= 45211.2114
ADDRESS= SPOKANE WA 99206
PERMIT USE= SEWER CONNECTION - #8801 (96S-1029)
PLAT#= 001852 PLAT NAME= OPPORTUNITY (TR. 1-142INC. 143-35
BLOCK= 202 LOT= ZONE= UR-3.5 DIST#= F
AREA= 00000000 F/A= F WIDTH= DEPTH= R/W= 40
# OF BLDGS= # DWELLINGS= 1 WATER DIST =
OWNER= BARBER, EVELYN PHONE= 509 926 2983
STREET= 11704 E 6TH AVE
ADDRESS= SPOKANE WA 99206
CONTACT NAME= FORD'S CONSTRUCTION PHONE NUMBER= 509 924 6182
BUILDING SETBACKS: FRONT= NA LEFT= NA RIGHT= NA REAR= NA
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
ENGINEER EXPIRED CONTRACTORS LICENSE
COMMENTS:
***************************** SEWER PERMIT ******************************
CONTRACTOR= FORDS CONSTRUCTION PHONE= 509 924 6182
STREET= 9713 E 4TH AVE
ADDRESS= SPOKANE WA 99206
ITEM DESCRIPTION QUANTITY FEE AMOUNT
PROCESSING FEE Y 10. 00
SEWER CONNECTION 1 40 .00
******************************* PAYMENT SUMMARY ****************************
PAYMENT DATE RECEIPT# PAYMENT AMOUNT
09/23/96 00009783 50.00
TOTAL DUE= .00 TOTAL PAID= 50.00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
PROJECT NUMBER= 96008045 APPLICATION DATE= 09/23/96 PAGE= 02
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
SEWER PERMIT 50. 00 50. 00 . 00
50. 00 50. 00 . 00
PROCESSED BY: CAROL FRAZIER
PRINTED BY: CHRISTY HARGRAVE
******************************** THANK YOU ************************************
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SEWER CONNECTION PERMIT
APPLICATION FORM
PLEASE NOTE: This application form must be filled out accurately and in its entirety, and signed,
or a permit will not be issued. Also mote that sewer permits are valid for 12 months from the date
of issuance. No extensions will be granted.
PROJECT INFORMATION
Job address: / Dry Line Owner's name:r
II/704 (� Sewer? �' N) 4,4_414 ,
City: �j p ant- W PV - City/S4te �k7'� "`-tom: �,y 1/h4
1
Zip: gq�n40 CaZip: qgjnee
Parcel number (if known): Phone:
ogSs
First-time contractors or home-owners performing the installation must first contact the utilities department (in
person or via phone [456-3604]) before a permit can be issued.
Name of Utilities Department person contacted:
CONTRACTOR INFORMATION
Contractor (company name): State contractor license number:
F o(d' S Con 5-ir c-1-iort rn a 6 S C.,C. 0 G L4 C 5
Business address: Utilities installers permit number:
3 c . 4 441
City/State: , pc)4(61,1\ \NIA
Zip: q G 2u Phone: 12-4- -
INTERIOR PLUMBING ALTERATIONS (f applicable)**
Contractor (if different from above): Phone:
Business Address: City/State/Zip:
** For plumbing reversal fee information, see reverse side of this form.
FEE INFORMATION
Sewer Connection: Number of Buildings X (times) $50 (per bldg) _ $
TOTAL FEE
* One permit required for each separate building, shop,garage, etc., that will be connected to the sewer.
* Condos, townhouses, &2-3- and 4-plot-require 1 permit per address/stub.
* Multiple buildings (apartments, industrial complexes) require 1 permit per building.
(For situations not covered here, call the County Utilities Division @ 456-3604)
APPLICANT SIGNATURE: Date:
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675