1991, 06-11 Permit: 91002037 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
CONTACT NAME= H E PHONE NUMBER=
BUILDING -EETBACKS : FRONT- NA- LEFT= NA RIGHT- NA REAR-= NA
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EEWER CONNECTION
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PAYMENT
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PERMIT ic.1—E 1.-EL AmoUNr AMOUNT PAID AmOUNT OWING
PROOESEED BY : FORRY , JEFF
PRINTED BY. jULTE' SHATTO
AE—BUILT INFORMATION TE ABLE AT THE COUNTY
DEPARTKENT (4'5677-3604)
i SEWER
TO LOCATE -P.URTED .LAS ,WATER HTNFE., FCT„.
CALL' BEFORE ( 4'56
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ARE TO BE CHECKED PRIOR TO CONNECTION Tfl TNEURE
TL'FY APE
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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 _
— — 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: a
Temporary C/O issued: _— _ _ Certificate of Occupancy issued:
Office file review by: __ —_ _ s__. 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: