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2002, 07-23 Permit App: 02006207 SewerProject Number: 02006207 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SEWER CONNECTION - SOUTH PONDEROSA Date: 7/23/02 Page 1 of 2 Setbacks: Front Left: Right: Rear: Site Information: wftesm Plat Key: 001742 Name: MYRON ESTATES #6 Parcel Number: 44042.1717 Block: SiteAddress: 4910 S GILLIS WAY CT SPOKANE, WA 99206 Location:: SPO Zoning: UNKN Unknown Water District: Area: 0 Sq Ft Width: 0 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Review Road Obstruction Permits: <, Contractor: ACME EXCAVATING Address: 721 N LILY RD SPOKANE, WA 99212 Item Description SEWER CONNECTION PROCESSING FEE Contact: Address: C - S - Z: Phone: Group Name: Project Name: Lot: ACME EXCAVATING 3021 N LILY RD SPOKANE, WA 99212 (509) 228-0691 Owner: Name: Address: District: F STREUFERT, PHIL 4910 S GILLIS WAY CT SPOKANE, WA 99206 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Released y: Server Connection Permit Firm: MAKE ORRINO/ACME EXCAVAT Phone: (509) 228-0691 Units Unit Desc Operator: CKF Printed By: CKF NUMBER OF Y OR BLANK Permit Total Fees: Print Date: Fee Amount $85.00 $15.00 $100.00 7/23/02 Project Number: 02006207 Inv: 1 t- Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 7/23/02 Page 2 of 2 Notes Payment Summary:< Permit Type Sewer Connection Permit woR Fee Amount $100.00 $100.00 Invoice Amount $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: CKF Printed By: CKF Print Date: 7/23/02