1996, 09-23 Permit App: 96008044 Sewer PROJECT NUMBER= 96008044 APPLICATION DATE= 09/23/96 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 11722 E 6TH AVE PARCEL#= 45211.2116
ADDRESS= SPOKANE WA 99206
PERMIT USE= SEWER CONNECTION - #8801 (96S-1028)
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= JACKSON, RON & SALLY PHONE= 509 924 0746
STREET= 11722 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 CONTRACTOR 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 00009782 50. 00
TOTAL DUE= . 00 TOTAL PAID= 50.00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
PROJECT NUMBER= 96008044 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 Lin Owner's name:
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City: ��n 1N i�
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Zip: qq O(1, Zip: gQl446 (,
Parcel number (if known): Phone:
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:
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Business address: Utilities installers permit number:
41113 C •
City/State:_ .DI{ L �A
Zip: q G 20 L Phone: ei 214 - (o 1 a2_
INTERIOR PLUMBING ALTERATIONS (if 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-plea-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
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