1991, 10-02 Permit: 91003804 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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ADDRESE- EPOKANF WA 99206
R- 509
4 5405
CONTACT NAME= DONNA i.., i .. ... PHONE _ _..
EETBACKE : FRONT- NA LEFT= NA RIGHT= NA REAR- NA
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CONTRACTOR= COURCHATNE CONSTRUCTION PHONE- 509 924 5495
ADDREEE., VERADAL WA 99077
ITEM DEECRIPTION QUANTTTY 1.-E17
:j i FEE 10 , 00
gEWER_ CONNECTION40 .00
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S�t�T -
PAYMENT DATE RECETPTO PAYmENT AMOUNT
10/02/91 7150 50 ,
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT owING
50, 00 50 .00 , 00
PRINTEDBY : JULIE EHATTO
EXCAVATION
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THAT THEY ARIT F.:I FAR ANT') iiNnn:7TRHflTPD To THE -:!EWER MAIN
:Ji:** ***:Iff: CALL FOR INgFECTION PRIOR TO COVER :k:kKKY:KK:k*
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456- 604
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