1991, 12-06 Permit App: 91008464 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 NUi`4BER= 910,li;46.<`
_ .... t APPLICATION C•iN Iiia i t::.-:: 12/06/9i PAGE=PAGE= t:ii
. C4
*-3+'X''X' T H I i NOT r; PERMIT •:. .•..
PENALTIESW]:L.i. BE:: ASSESSED FOR f::fiMME::±COMMENCING WORK WITHOUT r: PERMIT
--------
SITE STREET= 12624 4 E: 23RD AVE PARCEL4= 27542-3202
ADDRESS= SPOKANE WA 9921 6
PERMIT ,OE= SEWER CONNECTION c.:REET (91 —S123)
PLAT4= 0:09"1 > PLAT wrtE _ GAIL ' S PARK ESTATES
BLOCK= ) Lin= ft : -irag=
A :F : . � le, ;t ;0 f / = . • JT1I E: . .tt rW=
4 tl t•• s:+t...3 i(:.,`;:::: •t „• DWELLINGS= •t i,,iTl.o-,t``t t ±::.r; DIST ....
OWNER= I.:+'ARSL..c:tN, H i::1 PHONE=
,..EC�i�;E::-::
STREET= 'I j�''�.��•S E:' 23RD AVE
ADDRESS= SPOKANE: WA 99 '.
CisiNTAC.i.. NAME= iti-EE:::C: CONSTRUCTION SETBACKS : RIGHT=PHONE NUMBER=
UMT E • 509
448 3" 1BU�tiENG E , 1Ei: N; ; LEFT= N/A N/A REAR= N/A
.j,.**•P:P:*•P•r:•;,:**Y,.'R**it)J**.J..3G*.y..j{..jt i,:i1 SEWER t'E:.t'{t .t. i 9l*'P:*'k........jt.P:.N:•&•it::p.3f .';?'P:!l•.H:'p:'..'N:... iG
CONTRACTOR=TORn::::: ilriE::i' CONSTRUCTION PHONE=
: —: , , 44e ;
cy ."TEET= RT I BOX 38
ADDRESS= SPANGLE
WA 99061
ITEM DESCRIPTION ION kU"r _ Tfr
E::E:: r:y 1'1 ri Lii•i-E'
PROCESSING E"E::.E::. `f 10.00
SEWER CONNECTION r. r.ki.
PEPM]:T. TYPE FEE AMOUNT..:,_ � t AMi..i{.EVT PAID AMOUNT Ciixt]:NC;
SEWER PERMIT T 50.00 .00 50:.00
50" 00 ,00 50.00
PROCE
0 - -
E'ROCE::a,>EEIi BY : DOiSITRitV:ECH , ROBIN
PRINTED BY : DON]:TRri'ti I:C H , ROBIN
SEWER STUB AS—BUILT INFORMATION IS AVAILABLE AT THE COUNTY
UTILITIES
DEPARTMENT (4_ 6. hJry)
CONTRACTOR ri APPLICANT .t.S TO FIELD LOCATE .r•'t i•T I} CONFIRM E.i E::
i:ELEVATIONf:ANDi�'il,`>:E T:Ei:i?''. i:OF SEWER .. }- PRIOR TO ANY OTHER
EXCAVATION
TO LOCATE BURIED CABLES, c;AS PIPING, WATER LINES, ECT,
CALL BEFORE YOU ?.?.i.DIG (456-8000)
::•�r:.WEE STUBS ARE:. TO :BE:: CHECKED:HEC::KED PRIOR TC) CONNECTION iN T'C.i INSURE
R(:.
..rHI.IT THEY'i' t"•trtE CLEAR AND UNOBSTRUCTED TO HE SEWER R MA:1 i`I
CALL E'ri E`: INSPECTION PRIOR "E i,i COVER 9t••H:•A:P:•R•iA•:M..j{.j�..jl.
P N•:;,;ii'It r•P it•P; 24 HOUR NOTICE•" REQUIRED *it t u•aE it•r:it-.p.:r.
*iN. .* .*} 3f 3 ) .**3HiPi *. R1 *93 ** THANK YOU ( a Fr K ... F P J ..N !. F Y gY***I0h
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
—_— Road Plans/Improvements
___---_____ _ Bonds_
Planning— -- - -- - — . tends' . ..
- ' .,
Utilities Double Plumbing
— ULID
Other__ • ._
•
,.... «. TH1SSPACEFOR'COMMERCIALPLANS TRAPKING;-CgRTIFICATEOFOCCUPANCYONLy: „*«•>*`**..***°. °"•_•
Date received for 0/0 proces,S+pg: Plans:pulled for final processing,:
Temporary CIO issued __.. —_-��— . Certificate of Occupancy issued:
Office file review by: �� _ Date:
Filed insp finaled by: __—__-- —_ Date:
—
---
Ninety days after 0/0 issuance:
Owner/contractor called regarding the return of plans: _ Date: —_—__--
Plans returned: ---____-- . Received by:_ ---- __________
No response from owner/contractor-plans destroyed:_—