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2002, 07-18 Permit App: 02006047 SewerProject Number: 02006047 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 7/18/2002 Page 1 of 2 Project Information: ................................... ...................................................... Permit Use: SEWER CONNECTION - MISSION Setbacks: Front Left: Right: Rear: Site Information: ........................................:............... ........................................................ Plat Key: 000000 Name: UNKNOWN Contact: BAILEY CONSTRUCTION Address: PO BOX 149 C - S - Z: MEAD, WA 99021 Phone: (509) 467-5667 Group Name: Project Name: District: F Parcel Number: 45172.0508 Block: SiteAddress: 1324 N FARR RD Spokane, WA USA 99206 Location:: SPO Zoning: UNKN Unknown Water District: Area: 9,900 Sq Ft Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: :. Lot: Owner: Name: DERR, LARRY Address: 1324 N FARR RD SPOKANE, WA 99206-4050 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Review Road Obstruction Permits: Released By: _a slAS91 SI Contractor: BAILEY'S CONSTRUCTION Address: 3707 E 28TH AVE SPOKANE, WA 99223 Item Description SEWER CONNECTION PROCESSING FEE Sewer Connection Permit Firm: BAILEY'S CONSTRUCTION Phone: (509) 534-9605 Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Operator: DMD Printed By: DMD Fee Amount $85.00 $15.00 Permit Total Fees: 5100.00 Print Date: 7/18/2002 Project Number: 02006047 Inv: 1 Application Date: 7/18/2002 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Notes: Payment Summary:::: Permit Type Sewer Connection Permit Fee Amount Invoice Amount $100.00 $100.00 $100.00 $100.00 Amount Paid Amount Owing $0.00 $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 fmds 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. Sign a to re: Operator: DMD Printed By: DMD Print Date: 7/18/2002