2002, 04-04 Permit App: 02002229 SewerProject Number: 02002229 Inv: 1
Appl 'cation
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 4/4/02 Page 1 of 2
Project Information:
Permit Use: SEWER CONNECTION - EASTON 2
Contact: INLAND EXCAVATING & CONSTRUCT]
Address: 3417 W OLSON RD
C - S - Z: DEER PARK, WA 99006
Setbacks: Front Left: Right Rear: Phone: (509) 276-8500
Group Name:
Site Information: Project Name:
Plat Key: 000985 Nanie: GILLINGHAM 15]' ADD
District: F
Parcel Number: 45162.1029
Block: Lot:
SiteAddress: 10810 E CATALDO AVE
SPOKANE, WA USA 99206
Location:: SPO
Zoning: 11 12-3.5
Water District:
Urban Residential 3.5
Area: 12,420 Sq Ft Width: 90
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Owner: Name: LANG, ALICE
Address: 10810 E CATALDO
SPOKANE WA 99206
Hold: ❑
Depth: 138 Right Of Way (ft): 50
Review
Road Obstruction
oa sMicILL
Permits:
Sewer Connection Permit
Contractor: INLAND EXCAVATING & CONST Finn: INLAND EXCAVATING & CONST
Address: 3417 W OLSON RD Phone: (509) 276-8500
DEER PARK, WA 99006
Item Description
SEWER CONNECTION
PROCESSING FEE
Units Unit Desc
I NUMBER OF
1 Y OR BLANK
Operator: JAS Printed 13y: JAS
Fee Amount
$85.00
$15.00
Permit Total Fees: 5100.00
Print Date: 4/4/02
Project Number: 02002229 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 4/4/02 Page 2 of 2
Notes: ,
Payment Sununarv:
Permit Type
Sewer Connection Permit
Fee Amount Invoice Amount
$100.00 $100.00
$100.00 $100.00
Amount Paid
$0.00
Amount Owing_
$100.00
$0.00 $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 contrued 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: JAS Printed 13y: JAS
Print Date: 4/4/02
Spokane County Divisir n of Utilities
SEWER CONNECTION PERMIT APPLICATION FORM
PLEASE NOTE: This application form must be filled out accurately and in its entirety, air d signed, or a permit will not be issued. Also note that sewer
permits are valid for 12 months form the date of issuance. No extensions will be granted. A separate right-of-way permit is required for any work
performed in or from the county right-of-way.
PROJECT INFORMATION
Job Address: /0870 �, C(47/C./1 U
Parcel Number. Lot: Block:
Project Name: i'� 6� �)
ULID Name: �ifJ�tel-•
CHECK APPLICABLE BOXES
Regular
❑
Dry Sewer
❑ Repair
❑ Addition
❑ Abandonment
Residential 0 Ncw
O Commercial 0 New
O Temporary
Owner's name: / ' 1 c cLC/l,115
Address: /CV v C. CC.1,'}`1.1bo
Cin'/State
zip: %Sao (O
Phon
* FIRST TIME CONTRACTORS OR HOME OWNERS PERFORMING THE INSTALLATION MUST FIRST CONTACT THE
UTILITIES DIVISION BEFORE PERMIT(S) CAN BE ISSUED.
SIGNATURE OF UTILITIES DIVISION PERSON CONTACTED:
Contractor (company mole):
XhL it .7 5X+Z.052. H
S CCr,s�
Sate contractor license number:
Business address:
City/State: V Cr z w f e LuJJ Zip: 4'
z
Contact Name:
Phone Number:
INTERIOR PLUMBING ALTERATIONS? (yes no) rcle one
Fill an/ the information in the table below it -applicable'
Contractor (if different from above): Phone:
Business _Address: City/State/Lip
**For p/uwbinq rererral fee information, see reverse sideof ibis form.
Number of Buildings connecting to sewer
FEE INFORMATION
X (times) 5100 (per bldg) = 5 + 510.00 =
1110111' UI' WAN' PERMIT
• 1 sir a single-family residential unit, one penis is retained;
• Forcondominium, townhouse, J,lle., triplex or Couples nh separate ouner(hdl (v determined by lotlines) separate address10d se Iran ntu6
• Por a single building duplex, triplex or complex with single ownership, one permit is required
• 6Iu1tiplc buildings (apartments, industrial complexes) with single ownership, one perrnil required per building connecting to the zemer.
(FOR SITUATIONS NOT COVERED HERE, CALL THE COUNTY DIVISION OF UTILITIES AT 477-3604)
yui J per address ler soil);
Is amp of the work to be er • sit or in the c cot tight -of -wap? Yes 0 No
APPLICANT SIGNATURE: /
Method of Paym nt:
❑ Cash heck 0 Visa 0 MasterCard 0 Discover Card
Date: Expires:
Bankcard Number:
DATE: I!'
it 0
Authorized Signature-
'131
ignature:
'1'd
Spokane Goiania' Division of Building & Code 1l116woe neat
1(126 West Bo railway Avenue ' Spokane \Wt\ 992611
(509) 477-3675 Hit No. (509) 477-7198 r '111)1) Nu. (509) -177-7133