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2002, 07-30 Permit App: 02006427 Sewer Project Number: 02006427 Inv: 1 Application Date: 7/30/02 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-EASTON Contact: COURCHAINE CONSTRUCTION Address: 19818 E SPRAGUE C-S-Z: GREENACRES,WA 99016 Setbacks: Front Left: Right: Rear: Phone: (509) 924-5485 Group Name: Site Information: Project Name: Plat Key: 002718 Name: VALLEY MEADOWS SUB District: F Parcel Number: 45162.0963 Block: 1 Lot: 3 SiteAddress: 11305 E DEAN AVE Owner:Name: JEFFRIES,JOHN R&SALLY R SPOKANE,WA USA 99206 Address: 11305 E DEAN AVE Location::SPO SPOKANE,WA 99206-5080 Zoning: UR-3.5 Urban Residential 3.5 Water District: Hold: ❑ Area: 16,128 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: Review Road Obstruction Released By: l J S 110 Permits: :.a ti Sewer Connection Permit — Contractor: COURCHAINE CONSTRUCTION Firm: COURCHAINE CONSTRUCTION Address: 19818 E SPRAGUE AVE Phone: (509) 928-0846 GREENACRES,WA 99016 Item Description Units Unit Desc Fee Amount SEWER CONNECTION 1 NUMBER OF $85.00 PROCESSING FEE 1 Y OR BLANK $15.00 Permit Total Fees: $100.00 Operator: CKF Printed By: CKF Print Date: 7/30/02 Project Number: 02006427 Inv: 1 App1ica o1 Date: 7/30/02 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Notes: Payment Summary: Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Sewer Connection Permit $100.00 $100.00 $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: CKF Printed By: CKF Print Date: 7/30/02