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2004, 10-20 Permit: PO407649 Meter*** SPOKANE ,P 41 METER PER Applicant: LINDSEY CONSTRUCTION INC P 0 BOX 30792 SPOKANE WA 99223 Phone: 509 879 3420 PERMIT NO: P0407649 Project No: *0405353 DEPARTMENT OF ENGINEERING SERVICES 808 W. SPOKANE FALLS BLVD. SPOKANE, WASHINGTON 99201-3343 (509) 625-6700 FAX (509) 625-6349/(509) 625-6124 www.spokaneengineering.org * * * CONTRACTOR: LINDSEY CONSTRUCTION INC P 0 BOX 30792 SPOKANE WA 99223 Phone: 509 879 3420 Issued: 10/20/04 Validated by: SLH In applying for City water service, I agree: 1. I am bound by City requirements, including those of Spokane Municipal Code Chapter 13.04 and all terms and conditions of the Water Rates Resolution, as last adopted by the Spokane City Council. 2. To arrange for City inspection of the water connection prior to covering. 3. To pay all charges, including the DEPOSIT. PRICE WILL BE SUBJECT TO CHANGE, if not installed within one year from the date this permit was issued. Signed By: Connection: Tap On: Between: STREET: St. Width: Parcel No: Legal Desc: DOM CUSTER ST 13TH AVE AND END OF 1201 S CUSTER ST 100 35233.03020306 N 42' OF LOTS 4-5-6 Tap Size: Sewer Sys;Water Sys; Zip Meter Size - Meter Code: Installed In (bsmt,box): Fee description CUSTER YA nside BLK 3 1" 1 1" BOX ST City? I AND S 30' Acct # No. of Units: 1 Acct Type: RE OF VACATED 12TH ST ; E ; 99212 - 03 Units Fee/Unit Ext fee Data 1" Domestic? (Y/N) 24" Concrete Box? (Y/N). . . > TOTAL DEPOSIT Application Fee? (Y/N) Outside City Connection? (Y/N) > MUST Customer provide pressure reg- lator (pressure over 80 lbs.)? Y/N Was Annexation Covenant Signed? TOTAL COSTS Method Check # Receipt CK 234 P4#06012 TOTAL THIS DATE No. Date 10/20/04 ********* 475.00 Y 480.00 Y 955.00 30.00 Y N 985.00 Payment 985.00 985.00 Y NA