1991, 05-28 Permit: 91001648 Sewer SPOKANE COUNTY DEPARTMENT OF BUILDINGS
W. 1303 BROADWAY AVENUE
SPOKANE,WASHINGTON 99260
(509)456-3675
1 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
PROJECT NUMBER= ,••. ISSUED
*****************,k********** ,.:,.. ,.... .i...: - :t1. :!i;:11..j..j.:ii..j..j.:};:1j.:j.:'. f:?j..jf..,i.:,,..,1:.,w.y,.
, :..:!!.I!.!. ! �.a v Y••t;,�I•<["!1•n ( 1 !j'•. I?�•1:9.•sS':t 3i•. 1.). .1.J. :,.
A91.- PARCELO= 28542-2904
(;.M D! !::,:. :.. :t! !.1!'',f=Y!'t:. WR
PERMITUSE= SEWER CONNECTION i ttON .... NORTH Ktiii,.;.MO
PLAT:PLAT0= 001393 PLAT
NAME= K i..1k,i_jMU .I i ',,•,iNS!...
AREA= 00000000 I"/(.e.: F 4.1.!.f 1 i I"I:»: t 7!:. ! .Y ;
'x: t.i's" t:{L..I:la,::•:::: •e: !:?tk!::.! F....!.i'•t!,y,:.:::: 'I WATER DIET
OWNER= i !.!- t.v , RICHARD PHONE=
STREET= .10722 !::. .::•I E I {xi V!::.
ADDRESS= EPOKANE WA 99206
CONTACT CT M... i..,(,:., r.,, . . . PHONE
,i••+1-jc: Ni,.i!bj ;{1"I•!_:::: 509 922
8500
BUILDING!.: •::,.. ii•4i"?i, t' . FRONT= RIGHT= NA REAR=?.:iR NA
:,j..}j.:,?::y.:,,:sj...a::y.:{.a;..:j..?;.:j.:'.:'.:{.: :.:.i::::'...je,.:j2.:}..'7t-.: �•`i' I!" ' f^i::P M.t ..'j!;'Ai 3#'*'Pi.H.......*..9 ':1i 3!;3i'•11:31.3h 3{•3k 3k 31:31i 91r Pi 31:$1:**
..:. ,.1. ..,..5 :5 1.7.,.,.,. 1.15 71.}.}.1,+.75 75.. P :.:?.:.h?...:S .......!.i.«t
CONTRACTOR= ALWAYS ACTIVE PHONE= 509 922 8500
BOX 1 4 7
'.• ! !•':EE i :». PO BOX
ADDRESS= SPOKANE WA 99214
ITEM DC:.:.'•!.:!'.l.I t .?.i.)`e'`? QUANTITY !"F::.!::. AMOUNT
Ri_it.:i::.S _i vtr 'l::.!. 10.00
.,,EWER CONNECTION
40.00
.. .... .. .. ........ .. .......... .:•:t:::::'.:-.:t:'.:,t.f + .7.11• .7.7.P. 7. ....,. 5
.,,..p..p;.,,..P::n;.71:.71:.71:.1,:.p:.j1..et•M::'1:31:P:P.11.R N./t 1i 74 a jl•N:•3M 31r�Pi h '?'.�f��i•�!�'!i::.e` j ,j t.i j'!j`{r�l t•' `{• ..,.,f..Y•34.31i-j ,:3?i 3{•3S.jR}1..tl;�ij.:j.:• .:F.::.:�.: .�lk 3'.
PAYMENT DATE RECEIPT4 PAYMENT AMOUNT
0 5/ 2 3/`?1 2:?,^i :;%{:`..',:j0
TOTAL UE::::: . F'0 ..� i::�
1AL PAID=
- 1:1
��-•' i`;�
PERMIT TYPE F..E`•.. ,AMOUiy i AMOUNT PAID AMOUNT! ..;in ?.'Ni.r
EEWER PERMIT50 .00 50 ,00 ?:"j 0
50.00 50 .00 , 00
PRUCEED Br: JULIE SHATTO
PRINTED BY : JULIE S.... ? . ?
SEWER ;. ! ;.i,1.'t AS-BUILT INFORMATION ! •:' AVAILABLE {•i I"I E COUNTY
UTILITIES DEPARTMENT s
i.
APPLICANT CONTRACTOR .,t. !' .!., TO FIELD LOCATE AND .i i;'7, !_ •f!"i
ELEVATION AND POSITION OF SEWER ETUB PRIOR TO ANY 07HFR
EXCAVATION
TO LOCATE,j, i.:' Bi' " „ ii CABLES, i-=si•, PIPING, WATER 'rJ :;i ECT ,
CALL BEFORE YOU DIG (456-8000
SEWER
„ aERSTUBS
i , tB, . •E ;iCHECKED PRIOR I i ' {( CONNECTION
JNrs J ..t.f..i INSURE
THAT THEY-i {'•iR!:. CLEAR t ite 7StJ(.,1:•;.: ! Rl..jt.:i•!...I.:7 1•i? THE It::. ''1:.4i1?.R MAIN
<
*K******* CALL FOR R !.N t E k.. !. !N PRIOR •(iCOVER ;,...j1. 1 !f*31}1t n:'u•7e
;?'91:9t 3`.•.95.9k 3r,95.15 ::....y HOUR NOTICE REh'>..?.!.!'4!::.j.% 3F 3F 1N.9t J9 3`:?i•9 *3{
.,4..71:•75••A$:•71:3::*:f 456-3604
.1•:.71..7 .�..?;.::..j{ 1..j(..1l
., : : t 9 : 1 1 $ *9 9 3 9 9 41 , 1 1 :1 a ::: . : G 3 i 3THANK� Y „% 3P ' H9 ! 31i 3 3 }t 3ti 3j13. .k 7 1 *1 h yR R) 3
j.
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: ____________