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2002, 09-09 Permit App: 02007722 SewerProject Number: 02007722 Inv: 1 Application Date: 9/9/02 Page 1 of 2 THIS IS NOT -A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SEWER CONNECTION - CHRONICLE Contact: BAILEY'S CONSTRUCTION Address: E. 3707 28TH C - S - Z: SPOKANE, WA 99223 Setbacks: Front Left: Right: Rear: Phone: (509) 532-0705 Group Name: Site Information: Project Name: Plat Kcy: 002480 Name: SPRAGUE STREET ADD District: D Parcel Number: 35232.1913 Block: 19 Lot: 1112 SitcAddress: 220 S CUSTER ST SPOKANE, WA USA 99212 Location:: SPO Zoning: UR -3.5 Water District: Urban Residential 3.5 Area: 13,500 Sq Ft Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: Review Road Obstruction 5LJ 77 Permits: Owner: Name: SPLAWN, VIRGINIA M & RAYMO Address: 220 S CUSTER ST SPOKANE, WA 99212 Hold: Lil Depth: 0 Right Of Way (ft): 0 Released By: Sewer Connection Permit Contractor: BAILEY'S CONSTRUCTION Firm: BAILEY'S CONSTRUCTION Address: 3707 E 28TH AVE SPOKANE, WA 99223 Item Description SEWER CONNECTION PROCESSING FEE Phone: (509) 534-9605 Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Operator: CKF Printed By: CKF Permit Total Fees: Fee Amount $85.00 $15.00 $100.00 Print Date: 9/9/02 Project Number: 02007722 Inv: 1 Notes: Application Date: 9/9/02 Page 2 of 2 THIS.IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Payment Summary: Permit Type Sewer Connection Permit Fee Amount Invoice Amount $100.00 $100.00 $100.00 5100.00 Amount Paid $0.00 $0.00 Amount Owing $100.00 $100.00 Disclaimer: Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: CKF Printed By: CKF Print Date: 9/9/02