1991, 05-23 Permit App: 91002787 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 additionI have reaand 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 ORAGENT DATE
_ _
PROJECT NUMBER= 9i002787 APPLICATION DATE= 05/23/91 PAGE= Oi
****** THIS I% NOT A PERMIT ******
PENALTIE% WILL BE A%%E%%ED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET=%TREET= i2502 E 16TH AVE PARCEL4= 27542-0609
ADDRESS= %POKANE WA 99216
PERMIT USE= %EWER CONNECTION - 8801
*** SEE NOTE ***
PLAT4= CONVRT PLAT NAME= CONVERTED CNTY DATA
BLOCK= LOT= ZONE= AGJUB DI%T0= F �
AREA= 00012000 F/A= F WIDTH= DEPTH= R/W=
0 OF BLDG%= 0 DWELLINGS= 10 WATER DIET = *M
OWNER= T MA% RALPH H PHONE=
STREET= i �
O2 16TH AVE
ADDRE%%= SPOKANE WA 99216
CONTACT NAME= RON %LOAN PHONE NUMBER= 509 922 8500
BUILDING SETBACKS : FRONT= NA LEFT= NA RIGHT= NA REAR= NA
***************************** SEWER PERMIT ******************************
CONTRACTOR= ALWAYS ACTIVE PHONE= 509 922 8500
%TREET= PO BOX 141562
ADDRESS= SPOKANE WA 99214
ITEM DE%CRIPTION QUANTITY FEE AMOUNT
------------------------- --------
PROCESSING FEE
FEE Y iO .00
%EWER CONNECTION i 40.00
PERMIT TYPE FEE AMOUNT -AMOUNT PAID AMOUNT OWING
--------------- ------------- ------------
SEWER PERMIT PERMIT 50.00 .00 50.00
------------- ------------
50.00
,00.0O 50.00
PROCESSED BY : JULIE %HATTO
PRINTED BY : JULIE %HATTO
SEWER %TUB A%-BUILT INFORMATION I% AVAILABLE AT THE COUNTY
UTILITIE% DEPARTMENT (456-3604)
CONTRACTOR OR APPLICANT IS TO FIELD LOCATE AND CONFIRM THE
ELEVATION AND POSITION OF SEWER %TUB PRIOR TO ANY OTHER
EXCAVATION
TO LOCATE BURIED CABLES, GAS PIPING, WATER LINES, ECT ,
CALL BEFORE YOU DIG (456-800O)
SEWER STUBS ARE TO BE CHECKED PRIOR TO CONNECTION TO IN%URE
THAT THEY ARE CLEAR AND UNO TRUCT D TO THE %EWER MAIN
********* CALL FOR INSPECTION PRIOR TO COVER ****ii:*:******
********* 24 HOUR NOTICE REQUIRED **********
******** 456-3604 **********
******************************** THANK YOU *********************************
r• •
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
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:
q. 1 - a-`�� � Dep11
,
JOB ADDRESS: EET ` D6c5Q—
SUBDIVISION: 3 6 ZD< LOT: BLOCK: aJ
OWNER: F Ll PHONE:
ADDRESS:
CONTRACTOR: A l.(.cJ Z; A, l c�-e_ PHONE:
ADDRESS:
LICENSE #:
INSPECTION DATE:
TYPE OF OCCUPANCY: