1991, 03-28 Permit: 91000501 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
PERMITPRO:kili NUMBER= -71v00501 ISSUED
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SITE STREET= i0920 E 19TH AVE EARCEL4= 28542-4204
ADDRESS= SPOKANE WA 99206
PERMIT
ER` I. USE= _ : r : " i - ' q- t . ' — NORTH K
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FLAT = 002393 FLA1 NAML::::
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AREA=fI' /f i= I" WIDTH=7 -? t;!t;i DEPTH= ,•,,-> ±,.i:::. r'.;;i
ATER DIST =
, STREET= 10920 E
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CONTACT(•ti_: i `?,'•`ii"?t:.:::: ;...?::.i,ljJ{i•,'•°.`.:ii .... H s.., i�'i•-i�li�J;„ ;iii„is4St fes'_.. ..t�i`.>% _.... ... r's-v'
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BUILDING SETBACKS : FRONT= {-J f 1 !._±':{•• t :::: :`�r�± RIGHT- t'i r•:{ ?._?'t. ,;;.:!
:t !;:fi'it'*:t'h:'N:*:+i i+i:+;i?=*-it 4!i i++i:t••n:''r•;i}i'•i4 fi:i in:;y.!,..!!,.n; .. W C..R PERMIT ************************K*****
CONTRACTOR= 1'i is+. E i...t;1 j Ii1 ii: ? a.;i?' PHONE= 509
ADDRESS= SPOKANE WA 99206
ITEM DESCRIPTION QUANTITY '?:..!._ F4 CIi..ii_ti•
_.;..:�.: ..:I:. '+° ,NJ.i:r FEE {. j-i: -i};i
.:E�+ niCONNECTION '1 •t??.,! , t:7t'k
�, !..tri�::.':
uniinAe nN3t Ft SH n * nn ?: : : nniij! aPAYMENT s1 ”M( Ry * • ' : 4 ?! 3 . t.** tt.n.a! ! nnnt
PAYMENT, } , F RECEIRTO PAYMENT A1 O ?''`."
i•i.-�!•28,' ,r-1 •± 61 ,• 50„00
1 '`e::.i':!,_I, '; TYPE �'?::.?... AMOUNT AMOUNT PAID AMOUNT OWING
SEWER t`E?'_;±"±.±.'t ._.•_ia?.•;,.• ::jl:i..00 ..00
PROCESEED BY : ,
PRINTED BY : jULTE SHATTO
! SEWER .{ AS—BUILT INFORMATION IS AVAILABLE A'?• THE COUNTY
UTILITIES ???::.I''fl'±?" 1 ?"?I::N ? (456-3604)
CONTRACTOR to APPLICANT t tTO FIELD LOCATE AND D % ONFaRM H
:
ELEVATION r•try•! POSITION OF SEWER STUB PRIOR i'O f}'rJ'r OTHER
±::.Xt»:A'4 a.••'. ION
TO LOCATE BURIED 1:A)•fl :`i{, PIPING . WATER LINES: ....... ..
CALL BEFORE YOU tU S „. . •:
SEWER STUBS ttB,.'.• ARE TO BE CHECKED PRIOR TO CONNECTION TO INSURE
THAT{ t••:.. ARE CLEAR t::r'aIn At`dii UNOBSTRUCTED tit THE SEWER MAIN
st•**.A.r..n••n:)?'.R CALL f'?..;R I e�S I• t..t�T I i.i j`J PRIOR It.l COVER r:•i!:•}!;u•:i:i:e•a?•:!r•x
r? r ii : i ; ! .! i ! : ! n! ! r t :r �x: r! THANK
± ,n : t i ; ?l ;t 'iy :i3 . 1n: ni : ji } jJ ! ii ! .i.. . i .
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.__.____.____.
U L I D- — `--
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 tinaled by:____ -- — Date: -------
Ninety days after C/O issuance:
Owner/contractor called regarding the return of plans: _________________ __.__ _..____.______.Date _—_
Received by:____— ___ ________ _________________________
No response from owner/contractor-plans destroyed:_