1991, 05-07 Permit: 91002368 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 11( APPLICATION ` /9
OWNER OR AGENT ' l DATE J 7/ [ •
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SITE:... :..' ....-..... 11206 ,.. ...
•
DREEE- SPOKANE WA 5'9206
PERMIT USE= SEWER CONNECTION FOR KOKOMO
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OWNER= JEFRERT , NANCY PHONE=
ADDRES= EPOKANE WA 99206
CONTACT NAME— i BROTHERS PHONE NUMBER= 509 926 90P7
BUILDING, SETBACKS : FRONT:::: NA LEFT= NA Rt-,-•: : ;... NA t•C F is
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CONTRACTOR= HOLTEN BROTHERS
STREET= 11704 E 8TH AVE -
ADDRESS= SPOKANE WA 99206
ITEM DESCRIPTION QUANTITY FEE AMOUNT
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.., :- ., :-. :�. ... :.. :. :•. t-. a :-.,!.h A.-..t.A 9,:,,.,!.A P.i?.. .,A 1+.��:PROCESSING FEE 10,00
P A Y{`'S i:3'+. ! t'
, 05/07/91 2623 50,00
is tt.: AMOUNT i"
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50,00 50.00 . 00
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SEWER ...{;. :.ht AS—B OI ti : . ,
F { }CIS AVAILABLE AT THF LuuN1T
— — UTILITIES DEPARTMENf (456-3604 )
CONTRACTOR OR A I:' •. •%.i !' LOCATE AND CONFIRM THEELEVATION r.:"-,{�_r POSITION� . 'i�� SEWER STUB z � PRIOR 'i.:;; ANY
OTHER
EXCAVATION
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i..+ 4 f.'T }L �'t.?h i.l..y/.•t+.H} i. 'r.:. i.r: iia !'•, si:
_.ATL...{... ._t t i.}T.{... YOU t_}?-t,. .,156—000t_?;
SEWER E ! .!,('f
_ Ft { ; ii ' ! D
PRIOR { t k{ iI
t -
THAT }X?1}!:-YAtr }ft : iiUNOBSTRUCTED -TO l ` ' Wi ! Tir
?rnrhn CALL FGR E;x 1:P {r L t i U N t
! t i fi r?�!.*�{r? t 3t.
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24 HOUR, ,',.`,• ?• �..3 ,. ... REQUIRED+ -.. v..{ k:t.yy..}?'•f`:!:'*7.•R;!.
t;- THANK_, :,T..}..yi. :i. ;.}..:,.:t+!i:+`t:.:i Jt',.... :,:.j{.. :,k j;. .:,;.
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 finated by:__—_ —______ _____ Date:
Ninety days after C/O issuance:
Owner/contractor called regarding the return of plans: ________ _ Data
Plans returned: ________________------___________ Received by:_------______-- ___- ___ _________________
No response from owner/contractor-plans destroyed:__-___.___
022.5Y3 - 41?i 9
JOB ADDRESS: , /)49660
SUBDIVISION: /l F'4n LOT: to BLOCK:
OWNER: N_PfNC '/ 3! F RERr PHONE:
ADDRESS: t5/ -i b'
CONTRACTOR: 14OITE BP_OTH&IZS PHONE: 9P6) -9067
ADDRESS: E 1 044 e-619 A-0e
LICENSE # : 140CT8 h Li7 /9�
INSPECTION DATE:
TYPE OF OCCUPANCY: