1990, 10-25 Permit: 90005151 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
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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 N_
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: — -- —
SPOKANE COUNTY PAYMENT VOUCHER111=1:11111___________127020
VENDOR l rf. i i
CODE I SC I' ' DATE -:
NAME '-j & S CONSTRUCTION Aok% 1 - AGENCYNAME CODE LNi ORC L' r T
' AUDITORS STAMP
ADDRESS 11517 EAST VALLLY'4AY AVE. r
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SPOKANE, ',IA :`.�^�v? •'f�� . l^I alIlill"f s a
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ACCOUNT DISTRIBUTION,ORIGINATING ENTITY(ALL VOUCHER TYPES) ❑ 1099 REQ'D ID# 1.
LINE VENDOR ORGAN- SUB REV SUB JOB REPT" BS'
FUND AGENCY ACT OBJ DESCRIPTION AMOUNT
NO. INVOICE NUMBER RATION OBJ SOURCE REV NUMBER CATEG ACCT
1 `?0+3'25151 4O1 433 0500 4211 REFUND A?. )() t.
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DETAIL DESCRIPTION
am a1 1 IWORK I, the undersigned do hereby TOTAL >,�, '`
1 RL:=UND ON .1000551 OR ! lair) EAST 13'T.9 AVE, tide. NOT DONE, certify under penalty of perjury
PER COPY OF PERMIT ATTACHED that sufficient funds have been
budgeted for this claim, the ma- TRAVEL CERTIFICATION
$53.00 X 807; _ S40,r`n terials have been furnished, ser- I hereby certify under penalty of perjury
vices rendered or labor performed that this is a true and correct claim for
as described herein or contracted necessary expenses incurred by me and t
for, that the claim is a just, due that no payment has been received by me
and unpaid obligation against on account thereof. f,.
Spokane County or fund agency SIGNED
indicated above, that I am autho-
rized to authenticate and certify TITLE
INTRA-GOVERNMENTAL VOUCHER to said claim. DATE
SELLERS ACCOUNT DISTRIBUTION t
EXAMINED and ALLOWED
ORGAN- SU8 REVENUE Std RPT. (?FfSET
FUND AGENCY ACTIVITY JOB NUMBER PECEIVABLES
tZATION ORG SOItRCE gqC CA7EG. ACGL?IiNTC. � �
—�
j C3TIFICA ION DATE 19 `,
SIGNE ' .?,„_.._.:';'*;a. ) CHAIRMAN
SELLER CERTIFICATION
I,hereby certify that the materials have been furnished,the services SIGNED TITLE DI 7 I C E ADMINISTRATOR MEMBER
rendered or the labor performed as described herein or contracted TITLE '
for,and that the claim is a just,due and unpaid obligation,and that n/1 a/
I am authorized to authenticate and certify to said claim. DATE DATE " ` MEMBER '
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