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2002, 07-01 Permit App: 02005407 SewerProject Number: 02005407 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for coil fencing work without a permit Date: 7/1/02 Page 1 of 2 Project Information: Permit Use: SEWER CONNECTION - S PONDEROSA Setbacks: Front Site Information: 6.;44.,.. Contact: COURCHAINE CONSTRUCTION Address: 19818 E SPRAGUE C - S - Z: GREENACRES, WA 99016 Left: Right: Rear: Phone: (509) 924-5485 Group Name: Project Name: M . P. ..: Plat Key: 000875 Name: FOREST MEADOW ADD Parcel Number: 45333.0202 Block: 2 Lot: 2 SiteAddress: 4024 S FOREST MEADOWS D SPOKANE, WA USA 99206 Location:: SPO Zoning: UR -3.5 Water District: Urban Residential 3.5 Area: .00 Acres Nbr of Bldgs: 0 Width: 0 Nbr of Dwellings: 0 Review Information: u Review Road Obstruction Permits: Owner: Name: Address: NSIMMZETAMMAIMNAMMMVANIPERMMONAW District: F BOYD, JOHN E 4024 S FOREST MEADOW DR SPOKANE, WA 99206-9683 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Released By: o at SPA Sa_1 Sewer Connection Permit Contractor: COURCHAINE CONSTRUCTION Address: 19818 E SPRAGUE AVE GREENACRES, WA 99016 Item Description SEWER CONNECTION PROCESSING FEE Firm: COURCHAINE CONSTRUCTION Phone: Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Operator: CKF Printed By: CKF Permit Total Fees: (509) 928-0846 Print Date: Fee Amount $85.00 $15.00 $100.00 7/1/02 Project Number: 02005407 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for cainmencing work without a permit Date: 7/1/02 Page 2 of 2 Notes: Payment Summary: - Permit Type Sewer Connection Permit Fee Amount Invoice Amount Amount Paid Amount Owing $100.00 $100.00 $0.00 $100.00 $100.00 $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 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: CKF Printed By: CKF Print Date: 7/1/02