1991, 04-01 Permit: 91001062 SewerSPOKANE COUNTY DEPARTMEtATOF BUILDINGS
VK.13ODBROADWAY AVENUE
SPOKANE, WASHINGTON 99268
(50g)45G-3G75
1 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
d ordinances governing this type of work will be complied with whether specified
provisions included herein and agree to comply with same. All provisions of laws an uent inspection approvals or Certificates Of Occupancy shall not be construed to
herein or not. I understand that the issuance of this permit/application and any subseq warranty of conformance with the provisions of any state or local
give authority to violate or cancel the provisions of any state or local law regulating construction, or as a
laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
PROJECT NUMBER= 9iOOi�62 I%%UED PERMIT DATE= O4/Oi/9i PA�E= '
**************************** PERMIT INFORMATION ****************************
PARCEL�= 28543-43O8
%ITE %TREET= iO92i E 29TH A�E
ADDRE%%= %POKANE WA 992O6
PERMIT U%E= %EWER CONNECTION - %OUTH KOKOMO
*** %EE NOTE ***
PLA = OOi393 PLAT NAME= KOKOMO TOWN%ITEB DI%T� F
BLO��= 43 LOT= ZONE=
OOOOOOOO F/A= F �IDTH= =
if DWELLIN�%= i WATER DI%T =
- --�= %TCORNA�-`.'
����= ��G��-E�9T� A.E
X/ A. %POKANE WA 992O6
CONTACT NAME= JIM NIEL%ON PHONE NUMBER= 5O9 .:n 6O�7
B�ILDIN� %ETBACK%FRONT= NA LEFT= NA RI�HT= NA REA�= N�
***************************** %EWER PERMIT ******************************
CONTR CTOR= J.R. I CON%TR TION PHONE= 589 924 6O77
%rREET= 1O5O4 E VALLEYWAY AVE
ADT%RE%%= %POKANE till 992O6
ITEM DE%CRIPTION ' oUANTIT� .... '
------------------------- --------
PROCE%%IN� FEE Y iO.00
%EWER CONNECTION i 4O.00
********************�** PAYMENT %UMMARY ****************************
PuY�FmT ��TE RECEIPT� PAYMENT AMOUNT
' ' — - -
O4/�1/9i i7O3
TOTAL DUE= .00
PERMIT TYPE FEE AMOUNT
--------------- .... .... .... .... .... .... .... .... .... .... ---
%EWERPERMIT 5O.00
.... .... .... .... .... --------
` 5O.�O
5O.00
------------
TOTAL
A. 5O^OO
AMOUNT PAID
---.... .... .... .... .... ......... .... ....
5O.00
.... .... -.... .... .... .... ....
----
5O.00
AMOUNT OWIN�
-.... ... .... .... .... .... .... .... .... .... .... ....
.00
.... .... .... .... .... .... -.... .... .... .... .... ....
.�O
I- Y` BYTO
PRINTED BYJULIE %HATTO
%EWER %TUB A% -BUILT INFORMATION I% AVAILABLE AT THE COU�Ty
UTILITIE% DE�ARTMENT (456-36O4)
O TRAT R OR APPLICANT I� TG FIELD LOCATE AND CONFI�M T�F
L VATJ. O AND PO%ITION OF %EWER %TUB PRIOR T� AHY OTHER
EXCAVATION
TO LOCATE BURIEDPIPIN�, WATER LINE%, FCT.
CALL BEFORE YOUDI� (45�-8OOO)
%EWE� %TUB% ARE TO BE CHECKED PRIOR TO CON�ECTI8N TO I��|/RF
THAT THEY ARE CLEAR AND ;NOB%TRUCTED TG THE �EWER �AIN
***�***** CALL FOR IN%PECTIO� PRIO�
********* 24 HOUR NOTICE REQUI�ED **********
********* 456-3604 *,
'It' A*
******************************** THANK YOU *********************************
Project
Address:
Dept:
Dept. of Bldgs.
Engineer's
Planning
Utilities
Other
Date:
SPECIAL CONDITION CHECKLIST
Project #
Condition:
— Special Insp. Final Report
_ Hydrant ( )
— Lock Box
RID/CRP
Easements.._
Road Plans/improvements _
Bonds
Bonds
Double Plumbing
ULID
Init:
i (in)
Appr:
(out)
*.*.*..** **`****«*****«««**«* 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:
Plans returned:
No response from owner/contractor - plans destroyed:
-------_-. Date:
Received by: