1991, 02-14 Permit App: 91000508 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
APPLInATTON
a.3H,.....IH i...j..—K.K.G..:.?f..: i.J :.?:..: SnK p.:l}:** : *nAPPLICATION ap Yt a . 4a :.?y. t .: t:.?:.. b : : rfi: js; :.. ;:.1;..:.?:..i.i..a.j..:.,,..:.::s :y
i.i .:. L.. ,.i # t..L..5.:. S •_• l l _J.t F.. AVr. ,1,i t.if:...'i...a,.= 20543--
ADDRESS=
0..i.t.},i,....f•5:OI ES... •' i1'i,:Oit.;-iitit' WA 99206
PERMIT USE= :.:l...+hJ?._?•. CONNECTION NORTH
PLAT NAME= Kovomn TOWNSITF
BLOCK= %:`'i i...tr v, .... ZONE= AGSUB DIET4=
AREA= 000000-00 F/A= F WIDTH=
OWNER= „JEREMIAH, DAN PHONE=
STREET= ii219 E 25TH AVE
ADDRESS=- SPO ANE t.'JA 99206
CONTACT- NAME= LEONARD r : PHONE a[ fi -Rc509 . _ O966
BUILDING SETBACKS : FRONT== .p ?: LEFT= jRIGHT= i=•iA I"c`i�:.AR:::: _j'::
NA t�l t
*** .j.l.: j:i,* j: i**? L L jrjFiij** a* SEWER `is ' ; - . :S : jj: : n j: ryiJj:. j:J :.. .:i:: i:j:j. jj (
i
CONTRACTOR= H :.
S PHONE= 509 926 0964
ADDRESS= SPOKANE WA 99206
ITEM DESCRIPTION i:i i i i^(FgY ..i.:... A M t.' .. `
PROCESSING F :t'.' ri j.
,00
.. 40 , 00
PERMIT,; TYPE ! EEA iOUN AMOUNT r•J t t ;? AMOUNT OWING
i G
:
:::i::. :.il...it. PERMIT •�..}•• Ity ::.,J;? 50,00
50 00 ,00
,
PROCESSED
SEWER Iii:? AS—BUILT :INFORMATION AVAILABLE {. T-I h. COUNTY
UTILITIEE DEPARTMENT !, '176—760/Z )
CONTRACTOR ! APPLICANT
E i 'r C 'O�'t- FIELD' 1 a:ir, 1••.t•:l;::,..
.i FSS �•"'i....1. ,.�i'•i • .?.:.: ..J :i....?. ... .,{i_,t�t ��• i..,i'v--,. .i.,`_;!#',:
ELEVATION- AND POSITION OF SEWER ... ;i.t:f I::=1; I R .t O ANY i H i..,i,;
EXCAVATION
TO LOCATE BURIED CABLES,I,.i::• : I, A t PIPING, WATER L R ...- ? .. F . .. .
CALL.L .. E? '..+i",t:. Y t....l DIG i •t1;6--(5lS00)
SEWER
\ , ti ARE tBE CHECKED PRIOR
: , ' -sTO
CONNECTION INSURE
THAT 91 ' ( r _ ? I - at AND UNOBSTRUCTED 7i THE
SEWER MAIN
t*.}t•int•}(*'P:** CALL `y'" _ INSPECTION
l I TOCOVER ? l*:*w i a 9 }
t n* r*; K " s HOUR Ni� I :iREQUIRED -
:k*********
** *****4 r • r . r } } _ :.
: : : :? S # i :Y : ? l : iith A] : i ) ::::,i�..? ? f7 ' THANK YF: : u :j: i: :liji.J : : : i: : jg.,,.:: '79 : }
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SPECIAL CONDITION CHECKLIST
Project
Address: -- _Project Project# -------------__._._—_Use:________------------------------___---
Dept: Date: Condition: Init: Appr:
(in) (out)
Dept,of Bldgs. _----- ---_---_-
_. _ --- -- Special Insp,Final Report---__v__ ____________
_.___ _ _________ — — Hydrant ( )
— Lock Box — — — — —
Engineer's_—_ __ RID/CRP
_-- _ __ —_ _-- Easements ------------_._ — ___
-_____.—__ -- Road Plans/Improvements
Bonds
Planning------- - ._ Bonds
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 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
Received by:___-----____--
No response from owner/contractor-plans destroyed:___r__ .—_,