1991, 12-04 Permit: 91005689 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
PROJECT NUMBER= 91005689 ISSUED PERMIT DATE= 12/04/91 PAGE=- 01
*************-*************** PERMIT INFORMATION *•************•**-*********-****
SITE STREET= 10912 E 21ST AVE PARCEI...r-• 28542-3005
ADDRESS= SPOKANE WA 99206
PERMIT USE= SEWER CONNECTION -- NORTH KOKOMO
*** SEE NOTE ***
PLATO= 001393 PLAT NAME= KOKOMO TOWNSITE
BLOCK= 14 LOT= ZONE= AGSUB DISTK= F"
AREA= 00000000 F/A= F WIDTH= DEPTH= R/W=
0 OF BLDGS== 1 0 DWELLINGS= 1 WATER DIST ::-
OWNER= RAE, I) C: 4 T A PHONE=
STREET= 10912 E 21ST AVE
ADDRESS= SPOKANE WA 99206
CONTACT NAME= DONNA COURCHAINE PHONE NUMBER= 509 924 5485
BUILDING SETBACKS : FRONT= NA LEFT== NA RIGHT- NA REAR= NA
***************************** SEWER PERMIT ******************************
CONTRACTOR= COURCHAINE CONSTRUCTION PHONE= 509 924 5485
STREET= 16402 E VALLEYWAY
ADDRESS= VERADALE WA 99037
ITEM DESCRIPTION QUANTITY FEE AMOUNT
PROCESSING FEE Y 10.00
SEWER CONNECTION 1 40.00
******************************* F`AYMENT SUMMARY ****************************
PAYMENT DATE RECEIPT; PAYMENT AMOUNT
12/04/91 9181 50.00
TOTAL DUE= .00 TOTAL PAID= 50.00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
SEWER PERMIT 50.00 50.00 .00
50.00 50.00 ............_.__ ,00
PROCESSED BY : JULIE SHATTO
PRINTED BY : DOMITROVICH, ROBIN
SEWER STUB AS-BUILT INFORMATION IS AVAILABLE AT THE COUNTY
UTILITIES DEPARTMENT (456-3604)
CONTRACTOR OR APPLICANT IS TO FIELD LOCATE AND CONFIRM_THE
ELEVATION AND POSITION OF SEWER STUB PRIOR TO ANY OTHER
EXCAVATION
TO LOCATE BURIED CABLES GAS PIPING, WATER LINES, ECT.
CALL BEFORE YOU DIG (456-8000)
SEWER STUBS ARE TO BE CHECKED PRIOR TO CONNECTION TO INSURE
THAT THEY ARE CLEAR AND UNOBSTRUCTED TO THE SEWER MAIN
********* CALL. FOR INSPECTION PRIOR TO COVER **********
********* 24 HOUR NOTICE REQUIRED **********
********* 456-3604 **********
******************************** THANK YOU *********************************
SPECIAL CONDITION CHECKLIST
Project
Address: —___,__ —_Project#__ ______-- Use:
Dept: Date: Condition: Init: Appr:
(in) (out)
Dept.of Bldgs.
___ Special insp.Final Report __-
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Date received for C/O processing: ,.. t �•r�C;Plans,p�l(edf- f{naf pffocessir , j:i
Temporary C/O issued:_______ Certificate of Occupancy issued _ -----____--
Office file review by : }. j ; kl,#e
fi t :7":! t .,:: t ... ti .. . �r ;l; .. .i r,rj:� ..
Filed insp finaled by.' ;r,te Yt a{:+_ :,/1i:1 ; ] if1 : [Yate; �, ••1 i
Ninety days after C/O issuance:
,;;..,i .A4.s,:.t:./. .+t. it ;::(1•: ., :': +,..- :S•,: ,:.,1. ,,.,i.•!(•:i 4
Swner/contractor called regarding the return of ; -e' i -••I•
pa:'sbate:
ate:•rK,a,:,.,t.fl ,:..,{ 1 :r .Y.a :t..:e
_ _
Plans returned: -__.--------__-___ ---____—_ Received by: -------------____.
No response from owner/contractor-plans destroyed:__._____—_ ______________ ------- --------