1990, 10-03 Permit App: 90005113 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,oras a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
PROJECT i!_..1.'...(• i' 1.1i"iC:{ 'I•'= 90005113 DATE= 10/03/90 PA(;►:::::: 0
APPLICATION
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Al +?#?#::.Es:.. ,sF'oKA; E WA 9:7....':ir-
PERMIT U,::•E= :)EWER CONNECTION . KOis 't ' L.i
:.:. t: SEE NOTE r"**
PLAT4= 002393
BLOCK= 7
LOT= N A DIET-4
AREA= 00000000 F/A= }.. WIDTH= ,yl..;. , }_} R
-.r. OF
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O k i #,F r:: <:.i:lw N E'`f', NORMAN 1::'#••10N j;::::::
5 E 19TH AVE
ADDREES SPOKANE
WA 99206
CONTACT ` iM# : LEONARD . E ; PHONE t 509
:9r2ti , i: 3
BUILDING
S#::. t T{AC:< : FRONT= NA LEFT=:::: NA RIGHT= Nr':} REAR= NA
............ ....H_..... :............:
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coNiRAuTOR= y+ tvE CONSiRUciTON PHONE=.E 509 926 G964
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STREET= t i t.: j };', v;A}...t...E 3}}i f,'1'(- tyi 11':.
ADDRl::.E Ft,::: SPOKANE E Wf• i;'}r'l.
ITEM U.::.:;..:';3:L. ; t.i.;N QUANTITY F.. _:E:: AMOUNT
SEWER CONNECTION!-._i.)i`1.' '4 ,`:'y0
PERMIT#. ..E :rF`F.: FEE AMOUNT AMOUNT PAID AMOUNT OWING
:r
`i I:tri#:::#:;: PERMIT 50, 00 , 00 50, 00
50, 00 ,00 50 , 00
F:}.; 1, .. t , .. ..Y
PRINTED TFi:D :c•'r : ... .......IF.. ,.. .•-i;-;..;.-#';:'I
EWER ETUB AE—BuILT INFORMATION TS AVAILABLE AT THE CC
t.i I .I.L...1 I .#.E:,.; DEPARTMENT C.456-3604)
04
CONTRACTOR
t ? tht1' OR e4Fq7,1TCANTFIELD! , t :r :
AND CONFIRM
fN- ! M
I :
IEtei tiN AND POSITION t . , u : F ,!LB PRIOR 1( ANY OTHER
EXCAVATION
TO LOCATE E BUt IEa CABLES,S; (,AE PIPING, W TF::R ........ . ... . ECT,
777:ME YOU DIG (456-2000)
SEWER STUBS ARE TO -[,:{t::. CHECKED PRIOR TO CONNECTION TO INSURE
RE
THAT r--• THEY A tR.t::. CLEAR t-}kJ F'j UNOBSTRUCTED } ;.: ...,:}::r': MAIN
********:k
.4 t tCALL FORINSPECTION PRIOR t t} COVER .jk.ji..jyi.ji..Ni:1(.. ..it.Pt.jt'
.i********* 24 HOUR NOTICE REQUIRED -b-3t.**.R-k•-j?-7-yF 9{'
.jy.*fit••n:•n:*n:n•-R• 456-3604
•!e:9y:;`::'%::�: E'}:'H:A:•li•
.. .. is;.k i::-...... THANK :�.)t.: •}(•)i•1k)!-}t•)yr.}!It.*.fit.'?..f?.N. ...........................p.?Y* 7•jV
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 -- — ___.
— a ULID
Other
THIS SPACE FOR COMMERCIAL PLANS TRACKING,CERTIFICATE OF OCCUPANCY 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:
JOB ADDRESS: ),�) ` ! ?71-4
24
SUBDIVISION: c�- enc
SUBDIVISION: c-�' LOT: BLOCK:
OWNER: f ✓Z -k'=t ) ,xvLA PHONE:
ADDRESS:
/
CONTRACTOR: / J . PHONE:
ADDRESS:
LICENSE #:
INSPECTION DATE:
TYPE OF OCCUPANCY: