2002, 03-04 Permit App: 02001311 SewerProject Number: 02001311 Inv: 1 Application Date: 3/4/2002 Page 1 of 2
„
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Proiect Information:
SiteAddress: 720 S JERSTAD LN Owner: Name: GOOD SAMARITAN
VERADALE, WA USA 99037 Address: 17121 E 8TH AVE
Location:: VER GREENACRES, WA 99016-8556
Zoning: UR -3.5 Urban Residential 3.5
Water District:
Area: 11,000 Sq Ft Width: 100
Nbr of Bldgs: 1 Nbr of Dwellings: 1
ev'
R aew Information:
n
Review
Hold: ❑
Depth: 110 Right Of Way (ft): 30
Review by Utilities Released By:
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Permits: ::....:.:::
Sewer Connection Permit
Contractor: J S KIRKLAND CO
Address: 4005 S BEST
VERADALE WA 99037
Item Description
SEWER CONNECTION
PROCESSING FEE
Firm: J S KIRKLAND CO
Phone: (509) 879-4356
Units Unit Desc
1 NUMBER OF
1 Y OR BLANK
Permit Total Fees:
Fee Amount
$85.00
$15.00
$100.00
Operator: DMD Printed By: DMD Print Date: 3/4/2002
Project Number: 02001311 Inv: 1 Application Date: 3/4/2002 Page 2 of 2
THIS IS NOT A JPERMIT
Penalties will be assessed for commencing work without a permit
Notes .. .. _. .._ _ _.
Pament Summary:
ry
y
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: DMD Printed By: DMD Print Date: 3/4/2002