1991, 02-01 Permit App: 91000341 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,oras a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
PROJECT NUMBER= 91000341 DATE= 02/0:1 /91 PAGE= 01
APPLICATION
.i;.:,;.:;. ::i•:!.:•.:,;.:s•j(.:N.,:.:{.3i 3:•3:•3 3k 3}i 1:•3:•3?••.!•3:•Yi N•3:'3:•x'* APPLICATION ************ ************** **K*
STIE i::. k 1 i•C t••!:•, :::: .i t;1 O4 ?:: 26TH t..} A%i E .iA Pt:•:F •• 28543-3504
ADDRESS= SPOKANE WA 99206
.. 6
PERMIT t : -cSEWER
Fi ? 1yN. , 1IiEi : :
RESIDENCE
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NOTE I::: 3 :1:N'
,..?T 4,.__ 001393 PLAT NAME= KOKOMO TOWN ;i;'i'i-:
BLOCK=.... .g ,...'•..l i .... : 't (livf::.= f::4 G St.i i:i T:I E.TO'•• I»
OWNER= M OR`.'°.1 u' ::A PHONE=
STREET= 10904 E 26TH AVE
f?!.? .1%f',' :::: EP11i,ANE $A 99206
. sCONTACT vi , JIM
: : _ .I N PHONE NUMBER= 509 . '
4 6077
BUILDING SETBACKS : P'Ri,,iN t :::: NA LEFT=-i•::.. j''?r't RIGHT=:::: NA REAR:::: ktf.:,
s:a:.:::::,(.a;.:,;.:¢:(.:;.';.:j.:,f..,:..*s;.:,;.:,{.:;.:r.:•.a;.:i.:,[.:•..;.:•. ^' 'F R I::'F i:;,.,5.,...I. ******************** ******KK.. iR•
,±:,J±n......1. 1. 1.4.1...}... n.. .•. ....1.1•. P.:. 1. .. !±}.fl. :.>�.:.�).._? ._. . .:.
CONTRACTOR= ..I:. `'.. II ct::i v,`• RUCT I f'.i PHONE=1f :::: _ .
STREET= i0504 r.:•. VALLEYWAY AVE
ADDRESE= SPOKANE WA 99206
ITEM DESCRIPTION QUANTITY is E r AMOUNT
t
PROCESSING I=EI+Ej ti .
SEWER CONNECIION 40 .00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
-
•'A R ::: Fc t ...i 50 .00 :.00 50.00
50.00 .00 50.00
PROCESSED BY : JOHN i...11?-ti,•:.ii
PRINTED
BY : JOHN RS: N
,•l::.i:.t t_•.PC S ? I,i ; AS—BUILT INFORMATION ..... AVAILABLE A .r.l..l E COUNTY
UTILMEE DEPARTMENT (456-3604)
CONTRA
TOR OR APPLICANT IE TO
ATEAND CONFIRM
ELEVATION AN I-'I..i:.•.?. I .?.I.;i'i:' OF :S i-,tAti-.?-. STUB
PRIOR ANY I OTHER
t•tl:.�?•••THE
EXCAVATION
TO LOCATE r.: I .,,.,: t r t1 CABLES, GAS .PIPING, 't ii ;;:CALL BEFORE YOU •� I: �.
DIG
SEWER •;. i i.;B,:? f•3 t',t... TO BE !.:?-t t:.t.:I<. :: :.: s;.l...t R TO CONNECTION I I •, l:i"'a;';I..I•`;;::.
THAT THEY ARE CLEAR AND UNOBSTRUCTEDTO THE I WI:"FE. MAIN
::"�i!3i•ii 3r a 3 u CALL FOR!l .I I J i'�: :`..I I.,.•i i,.j ;:;:'r 'i I:;_ s-r: COVER •if:p i 3<::ry.:n:n.:n::'1.:;.
3:•3:•K•N:f::i3;t*•jt• HOUR NOTICE REQUIRED 3t'*i'****:t:3i.:•,.
4 ± PR; : ±9 ; 456-3604
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,,,,,,,,,,;,,,,,,,,,,,:..,,..,..,,..,....,...,..,;..],.?,.. ,. 3`r i`r!'iF:'-3� THANK �{7 f I
SPECIAL CONDITION CHECKLIST
Project
Address: Project# Use:____.______
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
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:
Plans returned: ____.__. ---.____ _--__.__-- . Received by:No response from owner/contractor-plans destroyed ----_____ _--_-__--_--------___-- ---___-_