1991, 11-27 Permit: 91006373 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
ISSUED PROJECT ±��1#'{rs••rc,=: 91006373 �.::•,�:t.11::.D ?"-#::.?'i#'1.1.T DATE= 11 /27/91 PAGE= ±,}'i
- #.. .# ± ,. 1 INFORMATION 4!:;:i.!:'*'!'i+e•9t fit Y•7!'•!r 1!•3r 3'*•'tr*'ir 9r*•)E'•/i)!ie'*cR•ie
SITE.E:. S # RE :. i = 11304 F 17TH i••1 i`E PARCEL.. -" 28542-2018
ADDRESS= EP° WA 99206
PERMIT USE= SEWER CONNECTION I.1„lN .... NORTH I..I KOI<OMO
}..}f.* SEE NOTE t"*r'
. ,10.1 . ... PLAT NAME-- KOKOMO TOWNSI-i'F
BLOCK= LOT= ZONE= AGSUB DISTO=
AREA= 000000'.n, (::`/f:1:::: i::' WIDTH= R./14=. "e
}t Or BLDGS= '1 ": DWELLINGS= t, WATER DIST T ::::
OWNER= WILLIAMS i.:HONE::::
STREET= 11304
17TH AVE
ADDRESS= SPO WAE.fJ9206
CGNTACT NAMES::.: ALWAYS ACTIVE PHONE NUMBER= 509 92. 8500
'n"
BUILDING SETBACKS : F ;:ON ± ••-- NA LEFT== I'd f•1 RIGHT= i''dfi REAR= NA
+::'±:•}k•**t+:***)i'P;'}+:)±::u::k•}?•**u::n: ±:•P:?!.:1?••jt.'R.:!}.'fi.j{: SEWER PE:'! M":' *********************,***K*****
C....'u... PHONE r..-.C) 977
STREET=E:::: `O BOX 141- :16.:.
ADDRESS.:: SPOKANE WA 99214
" ITEM DESCRIPTION . QUANTITY
PROCESSING F E :. '. 10 , 00
SEWER t CONNECTION
4+1,. 0')
i :i k i wk i} 3n ; , ni *hi nNk ;ri ,iN ; tViiti " aYN E::NT SUMMARY -}:;.y,;•}±i 3±:-}+i i+;*•M••i+i*ai**d?•*i}•**•i±::±r ±:iE iui i+,:;,+'..3+:}+:*
PAYMENT t DATE E REI' ;L: 1 A v 11 : a , AMOUNT MT
ii /27/91 9068 50., 00
TOTAL DHE= TOTAL P
' PERMIT T•`r :=E:: I-:EE:: iOUNT AMOUNT PAID AMOUNT OWING
�a i� _ F
EWER PERMIT MI ; :-:!:?:!:)!:? 50,00 ,00
50,00 50,00 .. -J::-}
PROCESSED BY : Jul..IE SHATTO
PRINTED BY : ITR iVI::::H i ROBIN
SEWER } % fAS—BUILT 1:\ . )Rt # ` TS AVAILABLE AT THE COUNTY
UTILITIES DEPARTMENT
'..
;.y6:....3,^ `b)
CONTRACTOR OR APPLICANT IS TO FIELD LOCATE AND CONFIRM THE
ELEVATION rv D POSITION I 1TvCFSEWER . „, iPRIOR -iF N t OTHER
FXF:A AT•:I:UIN
TO LOCATE(E rB^UR.I.ED CABLES,, GAS PIPING, uATER LINES, ECT,
_:
?CALLBF !"ORE” YYOUD:FrG (456-8000)
SEWER S ! t_i t s ' A It I TO BE .CHECKED I E.I:(:!i TO CONNECTION TO INSURE
THAT THEY f•,{•c E CLEAR AND UNOBSTRUCTED TO THE E ESIE" MAIN
,
•P:•N:.!.�.A.j,,.p..R..p, CALL r- ..#♦ INSPECTION PRIOR COVER , u-'st ;
********* 24. HOUR N O I t:,E REQUIRED M'il•.3h$k.3i k'•R***
456-3604 N:R•9C.R..Jl••J!..p..J,..R*
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SPECIAL CONDITION CHECKLIST
Project
Address: ,_ _ Project# Use:
Dept: Date: Condition: Init: 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:_ —_.�