1991, 03-28 Permit: 91000539 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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: ;L : . tNUMBER= 91000539 ISSUED PERMIT DATE= 03/22/91
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ADDRESS=k:::: SPOKANE WA 99206
1 PERMIT USE= SEWER CONNECTION — NO•; i i ''i.ii:!'..l•%iO
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PLAT NAME= KOKOMO TOWNEITE
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AREA= 00000000 i", !:`a::: WIDTH=i 1:::: a1t:'r'i'••i;::: I'
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i OWNER= r3• k3 ;; i PHONE—
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STREET='- t :t .h`.?.'i I :�''F;:J I i••i AVE
ADDRESS= Si OKANLIA 99206
I CONTACT !'dAt,t...... LEONARD ...- H
" ' , PHONENUMBER=
509 926 2964
1 BUILDING SETBACKS :, FRONT= NA LEFT= NA RIGHT= NA RE,; NA
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1 CONTRACTOR= CONSTRUCTION PHONE= �'a: 926 2964
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ADDRESS='S% ,JY.!-sj'V WA } :t•.'4 ,
4 ITEM DESCRIPTION ,::;UAN ? ?.TY}. +EE.#::....:....:.a AMOUNT
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I PROCESSING i•.It I: !.felt:; E E 10,00
SEWER CONNECTION i 40=.00
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PAYMENT DATE t"•:E!.:t::..t.t: ; :k: PAYMENT AMOUNT
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;,3 .20. :,y1 a 00
TOTAL DUE= ? ; TOTAL PAID= 50,00
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I PERMIT ! fP'g:. t..?::.k:. AMOUNT AMOUNT PAID AMOUNT OWING
PERMIT4 SEWER 50,00 t:
- 50.:O0 50,00 ,00
A PRINTED ... :.ii..i1...IE .S..A IC
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, SEWER STUB AS—BUILT INFORMATION I AVAILABLE.LA).5:....... A THE COUNTY
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1 CONTRACTOR OR APPLICANT I .O FIELD LOCATE A ( AND i,:O .�' _ Mt'tiE
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ELEVATION AND POSITION i.. SEWER STUB PRIOR TO ANY OTHER
1:k..CAVel T ",±,_lN
TO LOCATE BURIED CABLES, 1:r A::r PIPING, iaif-i i ±::.?", LINES, ECT ,
CALL BEFORE OU (456-8000)
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1 THAT • ,;`t:;?t.: CLEAR AND: t I tV 1.I:r.�y- ...2 t t�.t -i; TO THE:. 'SEWER MA ±
- •.?J?1?.0.�.A,?h K CALL FOR�j'; � jr. 4::`.•1•'1^1: ± ..�,t±JPRIOR .. COVER *******K**
******X-** 24 HOUR NOTICE t"°-:?:::i.+i j:?:RE:. s *****:k****
3,...******** 456—36±;1SL
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SPECIAL CONDITION CHECKLIST
Project
Address: —__- .__ Project# _.w User
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
""""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 0/0 issuance:
Owner/contractor called regarding the return of plans: _____ --_-______--_-__-- ---__--_— -_----- ____. Date'
Plans returned: Received by: ____-- --_.___-- ._ ____. ____ ______
No response from owner/contractor plans destroyed:________ _ _ _