1991, 04-01 Permit: 91001010 Sewer OrVi Mrd VVUi -1CrRrsIMCry I or DUILUIM-7
1W. 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
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SITE STREET= 1281.3 E 6TH AVE PARCEL4= 22542-1018
ADDRESS= ';- a K A N I-. WA 99216
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: , t.., t .�.._. ;-/.:7 , _..;•+-i'•:' PLAT NAME= t;i:I.: i !"•'.» 1 -354
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AREA= 00000000 F `{.:a::: i... WIDTH= - !?f:;, DEPTH= 300 Y:'/W= 40
i 4 OF s .....G : : :„: DWELLINGS= I WATER D is . •
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° OWNER=P ;: lti C 1 LY . s : THOMAS PHONE=� *I " _ }
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I STREET= 12813 E H AVE
3 ADDRESS=',j::•- SF C lt:ANE WA 99216
'• :O :.I : i NAME= ' . " :L : Ly} ; h , � N- "jR
§ BUILDING SETBACKS : FRONT= NA LEFT= NA=..a ..!.i..ft-1 ! .... NA l'=:r't"1 l't::[ I•J F:;
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9 CONTRACTOR= ALWAYS At.: t .ti E PHONE= ... .. . 2.... 8500
STREET= PO
BOX 14i562
1 AJ..... ... e_ SPOKANE %ii \ +?21 •.
i ITEM DESCRIPTION
I ...N .–:i t={N . .....i. . FEE AMOUNT
1 PROCESSING FEE - 10, 00
j SEWER CONNECTION 'p ,1,1i.J
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PAYMENT ,,;i.:: ! :' RECEIPT4 PAYMENTAMOUNT
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TOTAL t t•:17... D:.!t....... „00 TOTAL PAID= "i+:.t .
.00
s'l::.!'+.MI iw P t:. P'L.-:.. AMOUNT%,{�'T F:1 i'%i:J'U PAID AMOUNT OWING
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WWFR4PFRMIT 50.400 50,00 AO
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. PROCESSED BY : JULIE SHATTO
3 PPtNTED B Y :.i U L..I I::. S '.F: t . t.l
SEWER STUB UB AS.. BU:. A , a-I..1N .I.s AVAILABLE AT THE COUNTY
i UTILITIES DEPARTMENT (456-7... :t^i .
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CONTRACTOR i ICAC 11.}t'': iR til"i•I....I CA , I I t, I•• .L':.I..D 1...+.li.t''± I C:. AN ;iiN 1.i-t;` t HE
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ELEVATION AND;,: POSITION t,t�• SEWER :.: t i_?1: PRIOR I i., i_:�:_ ; OTHER
EXCAVATION
s TO LOCATE Bi :.I.E D CABLES, A\ PIPING, LtlA =. f•- LINES,
_ BEFORE: (.456-8000)
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A•)C-r:A,)E'r:)r)e:++: 24 HOUR relOt t" REQUIRED iC•Jr*•A•*i ie 3i*is
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:-.:�. :: :�. :�. :�.:; :. :. :,:�.r•.:. 7 7 S S �'t•9E 9:: THANK �Y;..i,? ii-)+:J...?Ya..1.7:..7.....tt•tk•lc i.r!...0-F... :y..lt i.....r. .. .... ..
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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. _-- —_
— U L I D _ —. _.__-- ____—__
_
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: _. _.-____.- ___ _�_____