1991, 10-02 Permit: 91003801 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 correctand athorize Sokane Conty to proceed with processing. In addition, I have reaand understandmo /wapsormwnsou/nswswTSvwnr/cc
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= 91003801 T=IED PERMIT DATE= 10/02/91 PAGE= 01
************************** PERMIT INFORMATION ****************************
SITE %TREET= 11004 E 21 %T AVE L�= 28542-3003
ADDRE%%= %POKANE WA 99206
PERMIT U%E= %EWER CONNECTION - NORTH KOKOMO
*** EEE NOTE ***
PLA 4= 001393 PLAT NAME= KOKOMO TOWN%ITE
BLOCK= 14 LOT= ZONE= AG%UB DI%TO=
AREA= OOOOOOOO F/A= F WIDTH= DEPTH= R/W=
4 OF BLDG%= i 4 DWELLINGS= i WATER DIET =
OWNER= JONE%, RAY PHONE=
STREET- 11004 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
***************************** PERMIT ******************************
CONTRACTOR= COURCHAINE CONSTRUCTION PHONE= 509 924 5485
STREET- 16402 E YALLEYWAY
ADDRE%%= VERADALE WA 99037
ITEM DE%CRIPTION QUANTITY FEE AMDUNT
------------------------- -------- ----------
PROCE%%ING FEE Y 10 . 00
%EWER CONNECTION i 40 . 00
******************************* PAYMENT %UMMARY ************************** *
PAYMENT DATE RECEIPTO PAYMENT AMOUNT
10/02/91 7158 50 . 00
TOTAL DUE=DUE= . 00 TOTAL PAID= 50 . 00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
--------------- ------------- ------------ -------------
EERMIT 50.00 5O ...OO . 00
------------- ------------
50 , 00 9n . o(.:)5O .00 . 00
PROCESSED BY : JULIE %HATTO
PRINTED BY : JULIE %HATTO
%EWER STUB A%-BUILT INFORMATION I% AVAILABLE AT THE COUNTY
UTILITIES DEPARTMENT (456-3604)
CONTRACTOR OR APPLICANT I% TO FIELD LOCATE AND CONFIRM THE
ELEVATION AND PO%ITION OF SEWER STUB PRIOR TO ANY OTHER
EXCAVATION
TO LOCATE BURIED CABLES, GAS PIPING ' WATER LINES , ECT ,
CALL BEFORE YOU DIG ( 45 -S000)
%EWER %TUB% ARE TO BE CHECKED PRIOR TO CONNECTION TO IN%URE
THAT THEY ARE CLEAR AND UNOBETRUCTED TO THE %EWER MAIN
********* CALL FOR INSPECTION PRIOR TO COVER **********
********* 24 HOUR NOTICE REQUIRED ***** * *
********* 456-3604 **********
**************** ************** THANK YOU *********************************