1991, 05-28 Permit: 91001100 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
i+.;Y i ' NUMBER- 91001100 ISSUED
DATE=
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SITE ETREET= 10011 : } t
L4= 28543
ADDRESS-C E"Olt,l:-?i;,::•. WA 992.00
PERMIT USE= :y • i,; vra 't,: iN .... I i"i r-I-iK�iiiI"?4
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±....e 7 .y..... 001393 PLAT NAME= i-,,it:i.??'?i.: 1 l,i irl?'+!::}I ?
. BLOCK= 7 LOT=.... tlt«!?rtl::. t-iGSU
u :J I" } ?...31(:,, .... 41: DI4F.....L_.I.?'?`v i WATER DIST
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0 d.t,1 ER= B:,t!-,j!i;W•T:V.`-. . i...?::.::> ? ?::.±' 1•• i::I..I0 NE
IWZOIM AVL
ADDRESS- ,..- : Kf-?ij ; WA 99206
CONTACT i Ac: Nf•1!"??::.= RON ' LOAN PHONE NUMBER= ...},a?:_y 922 ;.rj
BUILDING SETBACKS : 7 . ± p ± LEFT= ; a RIGHT- N t"'! REAR= NA
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CONTRACTOR= ALWAYS ACTIVE PHONE 5 0;;i
STREET= PO BOX
62
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ADDRESS= SPOKANE WA ::..i s9
ITEM DESCRIPTION QU.i I !. ("Et:. AMOUNT
PROCESEING FEE 10,00
SEWER CONNECTION .. ..
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i
... .......•t.:..I., ! ± PAYMENT! At?+.!iji'•! i
0_.. ........ :' 3 2-; ,", 50.00
TOTAL DUE= ,00 TOTAL PAID= 50,00
PERMIT TiYEFEL AMOUNT ACi : ' : PAID
iA` OL ` - OWING
SEWER PERMIT 500 50,00 •
J.
50,00 ... .. ,(' „00
±•-.t_•%.,I::.:.}:::L..:., `:�"! JULIE .}t"1(•1.x_.;.{-
I_.1:;...... . c.b BY : JULIE ,.;I"I t?'.
SEWER STUB AS—BUILT! INFORMATION AVAILABLE (':-.j _.H E COUNTY O t. N i'•.
UTILITIES 3!I::.i•AI.,. s M?::'?.! (456-3604)
is...3J._....:l.i?5Z:!4
CONTRACTOR OR APPLICANT
F
F
3C A* ! ` TO � o LOCATE AND
CONFIRM
ELEVATIONAND -; : ! ; r1 OF ; -, II _TIB PRIOR T; ±
OTHER
t
I::.Xt.:At{A ? ION
TO LOCATE BURIED i:A.B 2 tv A,: PIPING, WATER L...i.N:..,' ECT.
CALL t ORE:' YOU
'i.20'58—8000)
:.}!... •!...;t i !:,i:.: ;::;fC :. I O BE CALL : rL
OKt: , 10O .Nttt ; Q
THAT THEY ARE - tE ; AN ) » df } :' .; iiU ii ' , tz MAIN
f _ N
k*7 *$ LHi EOR INSPECTION PRIOR TO COVER t { k*P ' *iP
t•ia...`:...i
•:L
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.... HOUR NOTICE ?'S t::.!�;%.;;.?'t:?-.+.% :r***tr r it# ;.:,f.
.. .t!• it* a+:>: f56"•'$608 .............:*3 *
.r.!.i.!.!•.f{!.N!..,.,!.!{it fi....!,:t R.*1:..!±:::7?.1+: THANK T i..!!-,t 4`".•: t):9k Jt't+t*j..*r._,+..:.!:i?.:±f'to•ii•:±c i'.• ?''1t kc ;• `F•:±?•!?-9:)t,•:t±: !'ji•
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
— ULID
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:_ — —