1993, 07-15 Temp C of O: 93-5824 Sa,..ovQ-�•,,,o P
• 1
TEMPORARY CERTIFICATE OF OCCUPANCY fl 111 f `) zl °
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C REQUEST FORM ��
(. I am requesting a temporary certificate of occupancy be issued for the following project:
Project number: , ' - , i-/
Site address: P. — 6 a• , �=- -_ - �� � �
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Owner/occupant: 0--�.� - -
Use/description of project: ` k' 9---.
Reason for request: 1 -\A-fes, #2,, c �-% - _-
U•s0-'-q--t CAVI -/`/C iii—e `-`-� c i "A--z-e-,----
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Expiration date: - 44ii►'�o
On or before the above-mentioned expiration date, the following items will be completed: -
cr
I am aware that at the time of expiration of this temporary certificate, of occupancy, should
�-- any one or more of the above items not be completed. an additional charge of 10% of the building
permit fee (but in no case less than the minimum 1- of x$35.00) will be assessed to renew or
extend this temporary certificate and shall be pais ,f elthe Spokane County Department off Building
and Safety error to the issuance
of an su .- ;. rate. -�1
Sz
I am also aware that failure to comp t with 6 .;,.• --mentioned conditions of this temporary certifi-
cate•of occupancy may result in revocati. •' e certificate and as a consequence, I could be
subj-r a • • - penalty provisions contained in Title 3 of the Spokane County Code.
4( Date: 7—/S-71-3
By: A
Own:r/Authorized Dent
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Approved by: t _
/ Date: 7- !S - f3
Building Inspector
(
Project file conditions
reviewed by: Date:
forml7d 041390