1990, 11-15 Permit App: 90006195 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 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,or as a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
+••r:.,_}.tt...t.: I NUMBER= 90006195 „r_; ! r :::: ; , -,:9i•i PAGE=
OpLicATioN
} 9it ! 1h: t : 1 ii: 4PJi: Y: } idi * {: tAPPLICATION 9`3 " 1 : it3i1 }: ) ) :.,i..: } lPf :i :t ! J : t1 i „ mo
SITE STREET,- 12516 E 12TH AVE PARCEL4= 22543-9096
ADDRESS=
•71_'.!.'R._`.,.. - SPOKANE WA 99216
PERMIT USE= ,! WE;=. CONNECTION IO .... 0801i i:t` /Y E:.t' NOTE i`ie Vii.
Ft A'•i' 999:3)94.7; I::=I... ;?T NAME= RANGE
BLOCK= LOT= ZONE= AGRI ........
AREA= {.t F;t i;l i;t.;l t;f i}0 1 !(::?:::: !.. WIDTH= DEPTH= !•S°J tt i x:
•t±' OF Ja 1....t?tx,:;-:: ! .t,. DWELLINGS=
I.:iWNE.E,,::.. JORGENS : L. H PHONE=
STREET= 12516 E . 12TH AVE
ADDRESS= SF'OKANI;', WA . 9216
CONTACT NAME= LEONARD H 6 ::: PHONE NUMBER= 569 926 8964
,•RON•T•..:. . ,...!::...;.:::: t;,`..
BUILDING SETBACKS : FRONT=i,_±t'r i ... t,t(��? !...!::.± ! . .. . RIGHT=,.,f!..t ! :r.. !`J fj� .:t...r:.i It::::: e t f.a
........ ..... ..... „.,,...... ...1'
9k•P::t:;�!?••R:g{•qt;•lir•J+i•!i•3ti-iti'ii-•}�i•JL•Pi'}i:li•$+r i+i•'Pr�ti••Pr 7i•ii••!ti'P::R:••F: •.,,...,,,
:*.!::.IA!1':.I", !••i:'.I•t'i`'i,!, i 9C P:P:'P.ILIL!h'i±.''!1'*'P:!±:'P:P:'ti•},;.jl;.if;•ji•:tl;•}t;•tl.*•jt:•jl:•A:*:+t:4+:F:
CONTRACTOR= , CONSTRUCTION PHONE= 509 926 8964
STREET= 11817 E 1\'t='?`+....i...I:::'s`L)r•3`:i' AVE
E
ADDRESS= SPOKANE WA 99206
ITEM E : tT fi li - QUANTITY rr
AMOUNT
PROCESSING FEE } 'Y 9 . 01•!
ER
40.00
PERMIT
. :MI : : YiIFEE AMOUNT AMOUNT
MOUN. , , ItAMOUNT
M( UN» OWI
NGPROCESSED BY : JULIE SHATTO
SEWER PERMIT 50.00 .00 50. 00
50,00
50.00
;.�,}.
PRINTED .5.• wF U i....e.!::. S"!A ! 1 O
SEWER STUB ?: :,....i•:Ft i'( ;.r@r ;I•=:h " (1^i r::;;ii•:f:l:l...i�.;i:tl...l::. r'•?"i' THE COUNTY
U i ? S (:11:;.!.;...,, .. .
r.r
CONTRACTOR OR APPLICANT I: T FIELD e 3 AND " "
THE
ELEVATION AND POSITION OF SEWER STUB PRIOR -iI,! ANY OTHER
EXCAVATION
TO LOCATE BURIED CABLEE, t:, ; . PIPING, WATER `..... , ECT.
CALL BEFORE YOU DIG ,
000)
SEWER STUBS r'-1 t't t::. TO DE CHECKED !•' 1.!t•c; TO . CONNECTION TO INSURE
THAT t i E•t> Y f"i t'.t::. CLEAR I••t t•N DJ UNOBSTRUCTED 10 ! I-i l-. ''•:'I•:i;•;I-.i MAIN
iJ
*:l;.•k fi:3k?}:*•}t:•h: CALL FOR!•_. ? raS!..E:.E..T.I.ON PRIOR TO COVER •h:•k•r•ii•h;it•:q:Ti•**
k•9i•9c*Ji•)E-}i••}+::i• 24 HOUR t'QO ,•C2';, REQUIRED .i;.*j{.n.jt**•}k)t't+:
*K******* r5" . }i ; z :;Ps } } 4 : i ;
! } Vii*i ! N) *Pi iti9k**q *stit r } t THANK t , r rtfa $ iiiii3israc iis1r,r n ,
SPECIAL CONDITION CHECKLIST
Project
Address: Project# — Use:_
Dept: Date: Condition: Init: 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 — —
***— `""" —*****"'THISSPACEFORCOMMERCIALPLANSTRACKING,CERTIFICATEOFOCCUPANCYONLY""""'"""""""" —**
Date received for 0/0 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 atter C/O issuance:
Owner/contractor called regarding the return of plans: __ —_— —____.—_______._ Date:_.___ _
Plans returned: ______ —__—__ _--_____—__—_ _ . Received by: _____________
No response from owner/contractor-plans destroyed:__________
� e) I
JOB ADDRESS: l a 6 [ 0 / C0-7/4
SUBDIVISION: ,� - `M 9c LOT: BLOCK:
OWN 7,Q_f C� PHONE:
ADDRESS:
CONTRACTOR: PHONE:
ADDRESS:
LICENSE #:
INSPECTION DATE:
TYPE OF OCCUPANCY: