1991, 08-01 Permit: 91004025 Sewer SPOKANE COLNTY 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 additionI 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= 91004025 ISSUED PERMIT DATE= 08/01 /91 PAGE= 01
**************************** PERMIT INFORMATION ****************************
SITE STREET= ii2i6 E 21 %T AVE PARCELO= 28542-3114
ADDRESS= SPOKANE WA 99206
PERMIT USE= SEWER CONNECTION - NORTH KOKOMO
*** SEE NOTE ***
PLAT4= 004393 PLAT NAME= KOKOMO TOWNSITE
BLOCK= 15 LOT= ZONE= AGSUB DI%T#= F
AREA= 00000000 F/A= F WIDTH= DEPTH= R/W= 70
4 OF BLDGS= 1 4 DWELLINGS= i WATER DIST =
OWNER= HARRIS, JOHN PHONE=
STREET= 11216 E 21 %T AVE
ADDRESS= SPOKANE WA 99206
CONTACT NAME= JIM NIEL%ON PHONE NUMBER= 509 924 6077
BUILDING SETBACKS : FRONT= NA LEFT= NA RIGHT= NA REAR= NA
***************************** SEWER PERMIT ******************************
CONTRACTOR= J.R. II CONSTRUCTION PHONE= 509 924 6077
STREET= 10504 E VALLEYWAY AVE
ADDRESS= SPOKANE WA 99206
ITEM DESCRIPTION QUANTITY FEE AMOUNT
---- ---------------- --------
PROCESSING FEE FEE Y i8.00
SEWER CONNECTION i 40.00
******************************* PAYMENT SUMMARY ****************************
PAYMENT DATE RECEIPT4 PAYMENT AMOUNT
08/01 /91 5239 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 : JULIE SHATTO
SEWER STUB A%-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: !nit: Appr:
(in) (out)
Dept.of Bldgs.
Special Insp.Final Report
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Date received forCto procossing '' ,,�?9 ns puled fnr fhna4 pro eesinS ---
Temporary 0/0 Issued • t bccuOhcy
Office file review by Date
Filed Insp finaied by ,Pate
Ninety days after 0/0 issuance:
Owner/contractor called regarding the return of pians: __-- Date:
Plans returned: ------------------------ ___-- Received by:
No response from owner/contractor-plans destroyed: