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2002, 07-30 Permit App: 02006420 SewerProject Number: 02006420 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 7/30/2002 Page 1 of 2 Project Information: Permit Use: SEWER CONNECTION - SOUTH PONDEROSA Setbacks: Front Left: Right: Rear: Site Information: ........................................................ ........................................................ Plat Key: 000000 Name: UNKNOWN Contact: ACME EXCAVATING Address: 3021 N LILY RD C - S - Z: SPOKANE, WA 99212 Phone: (509) 228-0691 Group Name: Project Name: District: F Parcel Number: 44042.1712 Block: SiteAddress: 4813 S GILLIS WAY CT SPOKANE, WA USA 00000 Location:: SPO Zoning: UR -3.5 Water District: Urban Residential 3.5 Area: .00 Acres Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: > :......................................... ......... . Lot: Owner: Name: RAFAELO, LORRAINE N Address: 4813 S GILLIS WAY CRT SPOKANE, WA 99206-9440 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Review Road Obstruction oa S44.41-0 Permits: Contractor: ACME EXCAVATING Address: 721 N LILY RD SPOKANE, WA 99212 Item Description SEWER CONNECTION PROCESSING FEE Sewer Connection Permit Firm: MAKE ORRINO/ACME EXCAVAT Phone: (509) 228-0691 Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Operator: DMD Printed By: DMD Fee Amount $85.00 $15.00 Permit Total Fees: $100.00 Print Date: 7/30/2002 Project Number: 02006420 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 7/30/2002 Page 2 of 2 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 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: DMD Printed By: DMD Print Date: 7/30/2002