1991, 04-01 Permit: 91000400 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
PROJECT NUMBER= 91000400 IE,EUFD PERMIT DATE= 04/01 /9i PAGE= 01
: r : :.: : :: , c ,P „ar7R Y1r r : } siyr : : - i" sINFORMATION t*i *ri1 * £** r*J . .*.} *.4yi P :: t1R
SITE STREET= 11020 L,. 30TH AVE Pr'#R CE:....,,._.. 20543-5105
4"•,•••,••i;'::'... 99206
PERMIT USE= �:E:I,a?#: CONNECTION :i?I...I_i E'i A N MICA INTERCEPTOR PK ...
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L..i•? , t.... 001393 PLAT #'i!`?IL3E::..... I h 7,.#E'•:t.?3-'I O j #i La N E.'r. I i"... e
BLOCK= : ! LOT=:::. ::.t.?i 1.:.:::: g:,%v..;.t?; rt 1,., :�...:
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4 #:,_ ::I...t%i_fn:'":: 'I DWELLINGS=
WATER DISI MODEL
OWNER— RIVERS, -lf.1l:. PHONE=
N =
STREET= 11020 E 30TH AVE
ADDRESS= SPOKANE lLit-i 99206
CONTP , T NAME= STAN V �J t : :� iPHONE
RIGHT=� I O N. NUMBER=
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. . .
BUILDING SETBACKS : FRONT= Jr ; 1 -• _ ?: vf ' 'AR= NA
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CONTRACTOR= EiV ` r „ _ i .RD INC PHONE= 5< y 9 ' 5595
STRE
= PO BOX 141557
;.. .. SPOKANE W992
ITEM DESCRIPTION :..t_.A N t _. # rFEE i;.f..::i N
,
• Lip�...i
} #•7'i CONNECTION 1 00
::
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PAYMENT Db
- ?�:r•i..:.... . . . 'e PAYMENT Iii t.. I.
04/01 /91 Z6 r5 50.00
TOTAL
DUE , 00 PAID= ��j:':
TOTAL
.00
FEE PERMIT 11. # 1 Y fi'I:: 1"I::.+': r•?;"II..I4.?N I AMOUNT PAID AMOUNT OWING
iw#,
EWER P «RMII 50 . 00 50:_0; .00
50,00 S0 ,00 .00
PROCESSED BY :
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PRINTED .t:+Y : jULIE :S I'•I6•i # t I,
:.1'S
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,:+�...I�•I STUB AS—BUILT INFORMATION IS AVAILABLE f7. 1
UTILITIES t.)1::.I='t##'. I i t i::.N.`.. (456-3604)
CONTRACTOR OR APPLICANT , : TO FIELDLOCATE AND� _ _� :` THE
;
ELEVATION AND POSITION OF SEWER STUB
PRIOR TO ANY OTHER
EXCAVATION
TO LOCATE I::. sUE'.Ed/ t.:A?.fi„.#'•.'•. . GAS ... is Tia:% ; WATER LINES, ::.1.: I ..
as
SEWER STUBS
T t: ARE' ; BE ,: '1 ' ,It ( i .! CONNECTION;1.. { INSURE
4
.
.
THAT THEY ARE CLEAR AND UNOBSTRUCTED E THE SEWER MAIN.
:P.: 1 (H*fi4: CALL " i # N"rIIt PRIOR i COVER 3Pt : . iP*k
i) an) ) h7r, 24 t ! ` c " REQUIRED r33r ;i . ) *r
...........
.rt..,::at..R.x.r(.:X.:},.:x 456-3604 31:.y;.:pt.H.R''){';t•:n:3:'r:
g..'rr tt•3r•}r:,r'•rt•re::-2:•?t•f}:rr t.**sr*K..r,.,a}-.rt.:}!.rt:.r;*Y: THANK %%M... .. :.......:..
A
SPECIAL CONDITION CHECKLIST
Project
Address: __- _ _-._- __-� Project# -- Use:.
Dept: Date: Condition: !nit 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:
Received by: -_-- -
No response from owner/contractor-plans destroyed: _____ —__ -______