1991, 04-11 Permit: 91001115 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 NUMBER= 91001115 ISSUED PERMIT DATE:- 04/14 /9i PAGE= 01
***x*x********************** PERMIT INFORMATION k*** •***********************
SITE STREET= 15210 E 24TH AVE PARCEL=- 26544_-1715
ADDRESS= VERADALE WA 99037
PERMIT USE= SEWER CONNECTION •- DISHMAN--MICA INTERCEPTOR PKG ::4
*** SEE NOTE *•**
PL..AT4= 001593 PLAT NAME= MCLAUGHLIN ADD
BLOCK= 1 LOT= ZONE= AGRI DIST: = F'
AREA= 0000000() F,A= F WIDTH= DE"ETH= R:'W=: 60
M OF BLDGS= 1 0 DWELLINGS= 1 WATER DIST =
OWNER- JACOBSON, J W PHONE=
STREET= 15210 E 24TH AVE
ADDRESS=:: VERADALE WA 99037
CONTACT NAME= TERRY COURCHAINE PHONE NUMBER= 509 927 6760
BUILDING SETBACKS : FRONT-:: NA LEFT= NA RIGHT-: NA REAR= NA
***************************** SEWER PERMIT ******************************
CONTRACTOR= TLC CONSTRUCTION PHONE= 509 927 6760
STREET= 13816 E. i 2TH AVE
ADDRESS= SPOKANE WA 99216
ITEM DESCRIPTION QUANTITY FEE AMOUNT
PROCESSING FEE Y 10.00
SEWER CONNECTION 1 40.00
******************************* PAYMENT SUMMARY *************************n**
PAYMENT DATE RECEIPT: PAYMENT AMOUNT
04/11 /91 1980 50.00
------------
TOTAL DUE= .00 TOTAL PAID::- 0.00
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 AS--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 STUD 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
****•x•*** CALL FOR INSPECTION PRIOR TO COVER **********
********* 24 HOUR NOTICE REQUIRED **********
********* 456-3604 **********
******u************************* THANK YOU *********************************
SPECIAL CONDITION CHECKLIST
Project
Address: - --Project#_—
Dept: Date: Condition: Init: Appr
(in) (out)
Dept.of Bldgs.
Special Insp.Final Report_____ _-_-
Hydrant( )
Lock Box —
_
i t
RID/CRP
Road Plans/Improvements_-- ____ 5-1;=-, 4
Bonds---- — — _-- -
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Planning__ Bonds
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Date fc�
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Temporary C/O ssue!` —
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----------
Office file review by:•:!1!":!;, r !bate i —
Filed hasp finaled by. Date.
Ninety days after ://C issuance:
Owner/contractor called regarding the return of plans: ---_—______.__ _ Date-
Plans
ate Sr"',rid;returned: --.
Received by:
No response,from owner/contractor-plans destroyed:_--- ------ _