1991, 10-02 Permit: 91005475 Sewer SPOKANE COUNTY DEPARTMENT OF BUILDINGS
W. 1303 BROADWAY AVENUE
SPOKANE,WASHUNGTOm9g26o
(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
anu correct, and authorize Spokane County to proceed withpmvmmmu In additionI 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= 9iOO5475 I%%UED �`ERMIT D�TF= iO/�2/9i PAGF=
**************************** PERMIT INFORMATION **** ***********************
SITE STREET- 10921 E 28TH AVE PARCEL8543-3Gii
ADDRE%%= %POKANE WA 99206
PERMIT U%E= %EWER CONNECTION - %OUTH KOKOMO
*** SEE NOTE ***
PLAT4= 00i393 PLAT NAME= KOKOMO TGWNEITE
BLOCK= 38 LOT= 17 ZONE= AG%UB DI%T4= F
AREA= F/A= F WIDTH= iOO DEPTH= 100 R/w=
0 OF BLDG%= 0 DWELLINGS- i WATER DIET =
OWNER= COLLINS , EMMIA PHONE= 5o9 924 8374
STREET- 10921 E 28TH AVE
ADDRE%%= JPOKANE WA 992O6
CONTACT NAME= DONNA COURCHAINE PHONE NUMBER= 509 'P24 �48�
BUILDING SETBACKS : FRONT= NA LEFT= NA RIGHT= NA REAR= NA
*** ************************* %EWER PERMIT *********************** *****
CONRACTOR= COURCHAINE CONSTRUCTION PHONE= 509 924 5485
STREET., 16402 E VALLEYWAY
ADDRE%%= VERADALE WA 99037
ITEM DESCRIPTION QUAN ( liY FEE AMOUNT
------------------------- --------
PROCESSING FEE FEE Y 10 , 00
SEWER CONNECTION 40 . 00
******************************* PAyMENT %UMMARY ******** ******** **********
PAYMENT DATE RECEIPTO PAYMENT AMGUN�
10/O2/91 7241 50 .08
TOTAL DUE-DUE= . 00 TnTAL PAID= 50 . 00
PERMIT TYPE FEE AM3UNT AMOUNT PAID AMOUNT OWING
--------------- ------------- ------------SEWER PERMIT PERMIT 58 . 00 50 .00 ^ ��
------------- ------------
50 ,00 50,00 5O.00 . 00
PROCE%%ED BY : JULIE %HATTO
PRINTED BY : JULIE %HATTO
%EWER %TUB A%- UILi INFORMATION I% AVAI| ABE AT THE C3UNTY
UTILITIE% DEPARTMENT (456-3604 )
CONTRACTOR OR APPLICANT I% TO FIELD LOCATE AND CONFIRM THE
ELEVATION AND POSITION OF SEWER STUB PRIOR TO ANY OTHER
EXCAVATION
TO LOCATE BURIED CABLES , GAS PIPING , WATER LINES, ECT ,
CALL BEFORE YOU DIC ( 456-8000)
SEWER STUBS ARE TO BE CHECKED PRIOR TO CONNECTION TO TN�;RE
TI-AT THEY ARE CLE R AND UNOBSTRUCTED TO THE SEWER MAIN
********* CALL FOR INSPECTION PRIOR TO COVER *** ******
********* 24 HOUR NOTICE REQUIRED **********
********* 456-3604 **********
*** ************ *** ********* THANK YOU *********************************