2003, 05-02 Permit App: 03003077 SewerProject Number 03003077 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use. SEWER CONNECTION Contact: ROMAN JOHN
Address: PO BOX 236
C - S - Z: VALLEYFORD, WA 99036
Setbacks: Front Left: Right: Rear: Phone: (509) 990-0798
Group Name:
Site Information: Project Name:
Plat Key: 002873 Name: WEST VALLEY ADD
Date: 5/2/2003 Page 1 of 2
District: 11
Parcel Number: 45073.0116
Block Lot:
SiteAddress: 2102 N DICK 121)
SPOKANE, WA USA 00000
Location:: SI'O
Zoning- UR -3.5
Nater District -
Urban Residential 3.5
Area- 20,400 Sq Ft Width: 0
Nbr of Bldgs. I Nbi of Dwellings. 1
Review Information:
Review
Review by Utilities
Permits:
Owner: Name: ROMAR, JOHN
Address: PO BOX 236
VALLEYFORD, WA 99036
Contractor: OWNER
Item Description
SEWER CONNECTION
PROCESSING FEE
J2t,G+sa_ R)sr2->
Hold: ❑
Depth: 0 Right Of Way (ft): 60
Sewer Connection Permit
Firm: OWNER
Phone:
Units Unit Desc
1 NUMBER OF
1 Y OR BLANK
Operator. JEF Printed By. JEF
Fee Amount
$85.00
$15.00
Permit Total Fees: $100.00
Print Date: 5/2/2003
Project Number: 03003077 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
ost-
Date. 5/2/2003 Page 2 of 2
Notes: .-
DO NOT ISSUE SEWER PERMIT WITHOUT PERMISSION OF UTILITIES PER ROGER 2/6/98
SITE ALSO INCLUDES: N. 2104 DICK RD
Payment Summary:
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 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: JEF Printed By: JEF
Print Date: 5/2/2003