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2002, 05-06 Permit App: 02003386 SewerProject Number: 02003386 Inv: 1 l\pplication THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/6/2002 Page 1 of 2 Project Information: ............................................................ Permit Use: SEWER CONNECTION - EASTON Setbacks: Front Left: Right: Rear: Site Information: Plat Key: CONV Name: CONVERTED CNTY DATA Contact: COURCHAINE CONSTRUCTION Address: 19818 E SPRAGUE C - S - Z: GREENACRES, WA 99016 Phone: (509) 924-5485 Group Name: Project Name: District: U Parcel Number: 45162.1028 Block: SiteAddress: 111812 E CATALDO AVE GREENACRES, WA 9921)6 Location:: GRE Zoning: UR -3.5 Water District: Urban Residential 3.5 Lot: Owner: Name: FORD, DIANE Address: 10812 E CATALDO AVE GREENACRES, WA 9921)6 Hold: ❑ Area: 11 Sy Ft Width: 179 Depth: 138 Right Of Way (ft): 0 Nbr of Bldgs: I Nbr of Dwellings: 1 Review Information: Review Road Obstruction Released Bs a_ tr)9S 19 331 Server C'rnrnection Perurit Contractor: COURCHAINE CONSTRUCTION Firm: COURCHAINE CONSTRUCTION Address: 19818 E SPRAGUE AVE Phone: (5119) 928-0846 GREENACRES, WA 991)16 Item Description Units Unit Desc Fee Amount SEWER CONNECTION I NUMBER OF $85.00 PROCESSING FEE I Y OR BLANK $15.00 Operator: RMB Printed By: RMB Permit Total Fees: 5100.00 Print Date: 5/6/2002 Project Number: 02003386 Inv: 1 Appli \tion THIS IS NOTA PERMIT Penalties will be assessed for commencing work without a permit Date: 5/6/2002 Page 2 of 2 Payment Summary: Permit Type Sewer Connection Permit Fee Amount Invoice Amount $100.00 $100.00 5100.00 $100.00 Amount Paid $0.00 Amount Owing $100.00 50.00 $ I00,00 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 he 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 cont rued to he 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: RMB Printed By: RMB Print Date: 5/6/2002