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2002, 06-10 Permit App: 02004608 SewerProject Number: 02004608 Iny .1 a Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use. SEWER CONNECTION - EASTON Contact GIDDINGS CONSTRUCTION LLC Address 11812 E BIGELOW C - S - Z: SPOKANE WA 99217 Setbacks: Front Left: Right: Rear Phone: (509) 922-5907 Group Name: Site Information: Project Name: Date: 6/10/02 Page 1 of 2 Plat Key: 001836 Naine: OI'P.TR. 1-354 District: F Parcel Number: 45084.0409 Block: Lot: SiteAddress: 1712 N FELTS RD SPOKANE, WA 99206 Location:: SPO Zoning. AGSUB Water District: Owner: Name: SOUTHWORTH, ALBERT Address: 1712 N FELTS RD SPOKANE, WA 99206 Hold: ❑ Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 40 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Review Road Obstruction Released By: G& ye 1 010101— 02,S ISH4-bu, Permits• , Sewer Connection Permit - -- - - - - - - Contractor: GIDDINGS CONSTRUCTION Firm: GIDDINGS CONSTRUCTION Address: 11812 E BIGELOW SPOKANE, WA 99217 Item Description SEWER CONNECTION PROCESSING FEE Phone: (509) 922-5907 Units Unit Desc 1 NUMBER OF I Y OR BLANK Operator: CKF Printed By: CKF Fee Amount 585.00 515.00 Permit Total Fees: 5100.00 Print Date: 6/10/02 Project Number: 02004608 Inv. 1 a Appl ication THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 46/10/02 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: 6/10/02