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2001, 12-17 Permit App: 01010878 SewerProject Number: 01010878 Inv: 0 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 12/17/2001 Page 1 of 2 Project Information: Permit Use: SEWER CONNECTION - FAIR ACRES & Contact: H & S CONSTRUCTION PLUMBING REVERSAL Address: 11817 E. VALLEYWAY AVE C - S - Z: SPOKANE WA 99206 Setbacks: Front Left: Right: Rear: Phone: (509) 926-8964 Group Name: Site Information: Project Name:. . Plat Key: CONV Name: CONVERTED CNTY DATA District: 11 Parcel Number: 45092.0762 Block: SiteAddress: 3011 N GILLIS RD SPOKANE, WA 99212 Location:: SPO Zoning: UNK Water District Area: 0 Sq Ft Width: 0 Nbr of Bldgs: 1 Nbr of Dwellings: 20 Lot: Owner: Name: YOUNG, RONNIE Address: 3011 N GILLIS RD SPOKANE, WA 99212 Hold: 0 Depth: 0 Right Of Way (ft): 0 Review Road Obstruction 0/5x,fug341 Permits: Contractor: JACKSON PLUMBING Address: P.O. BOX 7272 SPOKANE, WA 99207 Item Description WATER PIPING - DWV PROCESSING FEE MINIMUM FEE ADJUSTMENT Plumbing Permit Firm: RANDY JACKSON PLUMBING Phone: (509) 926-7101 Units Unit Desc 1 NUMBER OF 1 Y OR BLANK 1 Select Operator: RMB Printed By: RMB Permit Total Fees: Fee Amount $6.00 $25.00 $4.00 $35.00 Print Date: 12/17/2001 Project Number: 01010878 Inv: 1 , A N " Application Date: 12/17/2001 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Sewer Connection Permit Contractor: 171 & S CONSTRUCTION Firm: 11 & S CONSTRUCTION Address: 11817 E VALLEYWAY AVE Phone: (509) 926-8964 SPOKANE, WA 99206 Item Description SEWER CONNECTION PROCESSING FEE Permit Type Plumbing Permit Sewer Connection Permit Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Fee Amount $85.00 $15.00 Permit Total Fees: $100.00 Fee Amount Invoice Amount $35.00 $35.00 $100.00 $100.00 Amount Paid $0.00 $0.00 Amount Owing $35.00 $100.00 $135.00 $135.00 $0.00 $135.00 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: RMB Printed By: RMB Print Date: 12/17/2001