2000, 12-14 Permit App: 00011193 SewerProject Number: 00011193 Inv: 1
Application
Date: 12/14/00 Page 1 of 1
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: SEWER CONNECTION - SHELLEY LAKE 2ND Contact: LEXINGTON HOMES
Address: 12218 NEZ PERCE LN
C - S - Z: SPOKANE WA 99206
Setbacks: Front Left: Right: Rear: Phone: (509) 924-1519
Group Name:
Site Information: Project Name:
Plat Key: 005977 Name: SHELLEY LAKE 2ND ADDITION District: F
Parcel Number: 45243.2402
Block: 3 Lot: 2
SiteAddress: 823 S GALWAY LN
VERADALE, WA USA 9903
Location:: VER
Zoning: UR -3.5
Water District.
Urban Residential 3.5
Owner: Name: LEXINGTON HOMES INC
Address: 12218 E NEZ PERCE LN
SPOKANE„ WA 99206
Hold: ❑
Area: 10,030 Sq Ft Width: 80 Depth: 90 Right Of Way (ft): 30
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Department
UTILITIES
Review
Review by Utilities
I Iolr�rceasons: GNL SO 1'-M I&N
Permit Conditions:
Release
Permits•
Server Permit
Contractor: FOLSOM EXCAVATING
Address: 16401 E VALLEYWAYAVE
VERADALE, WA 99037
Item Description
SEWER CONNECTION
PROCESSING FEE
Payment Summary:
Operator: RMB
Permit Type
Sewer Permit
Firm: FOLSOM EXCAVATING
Phone: (509) 891-1232
Units Unit Desc
1 NUMBER OF
1 Y OR BLANK
Permit Total Fees:
Fee Amount
$85.00
$15.00
$100.00
Notes: ,
Printed By RMB
Print Date:
12/14/00
Fee Amount Invoice Amount Amount Paid Amount Owing
$100 00 $100.00 $0.00 $100.00
$100.00 5100.00
$0.00 $100.00
•
Spokane County Division of Utilities
.
SEWER.CCNNECTION PERMIT
APPLICATION FORM
PLEASE NOTE: This application form must be filled out accurately and in its entirety, and signed, or a permit will not be issued.
Also note that sewer permits are valid for 12 months from the date of issuance. No extensions will be granted.
PROJECT INFORMATION
Job addresdPub-&N
1S23 5 -- - -_ _.. Uj.
City:
Zip:
Parcel number(aw,ow,):
Dry Line
Sewer? (Y/N)
Owner's name:
LEX I NCrmi) t+n-m E5 _7-7Nc
City/State: •% j lv
"9o
Zip: q
Phone:
Csoz) qac --/5,'q
First-time contractors or home -owners performing the installation must first contact the utilities department (in person or via phone
[456-3604]) before a permit can be issued.- -
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Contractor (company name):
�Sn m FU J ITI l'G--
Business address:
e • HHD o -i+ Vr 11sy o
�_it Tr
City/State:
Zip:
Phone:
Z
State contractor license number:
rot-,SUF. 033 Dtk
Contact Name:
Phone: 09) c77q - h002_
INTERIOR PLUMBING ALTERATIONS? (yes/no) circle one
Fill out the information in the table below if applicable**
Contractor (if different from above): Phone:
City/State/Zip:
Business Address:
.*.* For plumbing reversalfee tnformntton -see reverseside of thrs form
FEE INFORMATION n—e/r�—
Sewer Connection: Number of Buildings / X(times) $100 (per bldg) = $ / Cr' e
TOTAL FEE
• For a single-family residential unit, one permit is required;
• For a condominium, townhouse, duplex, triplex or fourplex with separate ownership (as determined by lot lines) separate
address and separate stub, one permit is required per address per stub;
• For a single building duplex, triplex or fourplex with single ownership, one permit is required
• Multiple buildings (apartments, industrial coma exes) with single ownership, ane permit required per building connecting to
the sewer.
(For situations not coved /• here, call the County Division of Utilities @ 456-3604)
APPLICANT SIGNATURE:
Date:
Return to:
Spokane County Division of Building d7 Planning
West 1026 Broadway Avenue * Spokane, Washington 99260
PHONE: (509) 456-3675 * FAX: (509) 324-3198 * TDD: (509) 324-3166
Spokme County don not djoamunate on the bene of do ebriate to the dnumon m of unnnent or emMorment mita programs or amnion
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