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2002, 05-15 Permit App: 02003751 SewerProject Number. 02003751 Inv: 1 1' tpp]cad On Date 5/15/2002 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 - FAIRACRES Contact: COURCHAINE EXCAVATION Address: 19818 E SPRAGUE C - S - Z: GREEENACRES, WA 99016 Setbacks. Front Left' Right Rear Phone: (509) 924-5485 Group Name: Site Information: Protect Name: Plat Key. 000765 Name FAIRACRES REPLAT #2 District' H Parcel Number. 45092.1213 Block: Lot SiteAddress' 11405 E GRACE AVE SPOKANE, WA 99206 Location': SPO Zoning UR -3.5 Water District Urban Residential 3.5 Owner: Naive. BRICE Address. 11405 E GRACE AVE SPOKANE, WA 99206 Hold: ❑ Area 0 Sq Ft Width r 0 Depth. (1 Right Of Way (ft) 0 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Review Road Obstruction Permits:if cid Sewer Connection Permit Contractor. COURCHAINE CONSTRUCTION Address 19818 E SPRAGUE AVE Phone: (509) 928-0846 GREENACRES, WA 991116 First COURCHAINE CONSTRUCTION Item Description SEWER CONNECTION PROCESSING FEE Units Unit Dcsc I NUMBER OF I Y OR BLANK Operator DMD Printed By DMD Fee Amount $85 1)11 $15 00 Permit Total Fees: $ 100 00 Print Date 5/15/2002 Project Number: 02003751 Inv: 1 Application THIS IS NOT --A EkMIT Penalties will be assessed for commencing work without a permit Date. 5/15/2002 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 $0.00 Amount Owing $10000 $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 he contrued to he 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 Bv: DMD Print Date. 5/15/2002