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2002, 07-18 Permit App: 02006036 SewerProject Number: 02006036 Inv: 1 Application Date: 7/18/02 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SEWER CONNECTION - SOUTH PONDEROSA Contact: ACME EXCAVATING Address: 3021 N LILY RD C - S - Z: SPOKANE, WA 99212 Setbacks: Front Left: Right: Rear: Phone: (509) 228-0691 Group Name: Site Information: Project Name: Plat Key: 001742 Name: MYRON ESTATES #6 District: F Parcel Number: 44042.1714 Block: Lot: SiteAddress: 4916 S GILLIS WAY CT SPOKANE, WA 99206 Location:: SPO Zoning: UNKN Unknown Water District: Owner: Name: FISHER, BARBARA Address: 4916 S GILLIS WAY CT SPOKANE, WA 99206 Hold: ❑ Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 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 Released By: `�,y [ rf. l Ei • Sewer Connection Permit Firm: MAKE ORRINO/ACME EXCAVAT Phone: (509) 228-0691 Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Operator: JAS Printed By: JAS Permit Total Fees: Fee Amount $85.00 $15.00 $100.00 Print Date: 7/18/02 Project Number: 02006036 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 7/18/02 Page 2 of 2 Notes: Payment Summary: Permit Type Sewer Connection Permit Fee Amount $100.00 cr • : >yAu`%., `+ e Vii ' ' 0,0, ,,,,3`:X4 Invoice Amount $100.00 Amount Paid Amount Owing $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: JAS Printed By: JAS Print Date: 7/18/02