1991, 04-02 Permit: 91001517 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 amonzo Spokane Conty to proceed with pmmmo.no 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 tr / DATE
PROJECT NUMBER= 9i001517 I%%UED PERMIT DATE= 04/O2/91 PAGE= 0
**************************** pERMIT INFORMATION ****************************
%ITE
STREET= 11124 E 25TH AVE PARCEL4= 28543-3ii0
ADDRE%E= SPOKANE WA 99206
PERMIT USE= SEWER CONNECTION FOR KOKOMO TOWN SITE
*** EEE NOTE ***
PLATO= 001 393 PLAT NAME= KOKOHOTOWN%TTE
BLOCK= 3i U]T= 7 ZONE= UR 3.5 DI%T4=
AREA= 00013000 F/A= F WIDTH= iOO DEPTH= 145 R/W=
0 OF BLDG%= 2 � DWELLIN�%= i WATER DIST =
OWNER= HAISLIP, THOMAE W PHONE= 509 928 2479
` STREET= iii24 E 25TH AVE
ADDRESS= %POKANE WA 99206
CONTACT NA^E= HOLTEN BROTHERSPHONE NUMBER= 509 926 9087
BUILDING SETBACKS : FRONT= NA LEFT= NA RIGHT= NA � REAR= NA
***************************** %EWER PERMIT ******************************
CONTRACTOR= HO EN BROTHERS PHONE= 509 926 6978
%TREET= 1i7O4 E 8TH AVE
ADDRE%%= SPOKANE WA 99206
ITEM DESCRIPTION QUANTITY FEE AMOUNT
------------------------- --------
PROCESSING FEE
FEE Y 18.00
SEWER CONNECTION 40.00
******************************* PAYMENT %UMMARY ****************************
PAYMENT DATE RECEIPT0 PAYMENT AMOUNT
04/02/91 1724 5O` 00
TOTAL DUE=DUE= . 00 TOT AL PAID= 50.00.
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
--------------- ------------- ------------
SEWER PERMIT PERMIT 50.00 '5:0.00 .00
------------- ------------ -------------
5000 50 .00 .00
:ROCE%%ED BY : JOHN LAR%ON
PRINTED BY : JOHN LAR%ON
SEWER %TUB A%-BUILT INFORMATION I% AVAILABLE AT THE COUNTY
UTILITIEJ DEPARTMENT (456-36O4 ) . .
CONTRACTOR OR APPLICANT IS TO FIELD LOCATE AND CONFIRM THE
ELEVATION AND POSITION OF SEWER STUB PRIOR TO ANY OTHER
EXCAVATION
TO LOCATE BURIED CABLE% GA% PIPING , WATER LIHE%, ECT .
� 1
CALL BEFORE YOU DI� (45"-8OOO>
SEWER STUBS ARE TO BE CHECKED PRIOR TO CONNECTION TO 7N%URE
THAT THEY -ARE CLEAR AND UNOBSTRUCTED TO THE SEWER MAIN
********* CALL FOR INSPECTION PRIOR TO COVER **********
********* 24 HOUR NOTICE REQUIRED **********
********* 456-36O�
******************************** 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
Engineer's __—_ — _-- RID/CRP -- __-- — ---
•
-----�.____ _-- Easements--------__ ---------------_ ____—.__- -- ------ ---------
-- — _-- Road Plans/Improvements------_—_--
Bonds_
�—
PlanningBonds------_-_--
Utilities Double Plumbing_
U L I D
Other------__ ��_ ^-------___---
THIS SPACE FOR COMMERCIAL PLANS TRACKING,CERTIFICATE OF OCCUPANCY ONLY
Date received for C/O processing: __________ —_.___..___ .Plans pulled for final processing
Temporary 0/0 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 Received by .----..--__-_--_-..._
No response from owner/contractor-plans destroyed: _ _