2002, 07-25 Permit App: 02006998 SewerProject Number: 02006298 lnv: 1
Application
THIS IS NOTA PMMIT
Penalties will be assessed for commencing work without a permit
Date: 7/25/2002 Page 1 of 2
Project Information:
Permit Use: SEWER CONNECTION - VALLEY RIDGE Contact: J S KIRKLAND CO
Address: 4005 S BEST CT
C - S - Z: VERADALE WA 99037
Setbacks: Front Left: Right: Rear: Phone: (509) 891-8211
Group Name:
Project Name:
005942 Name: VALLEY RIDGE (PUD) District: F
Site Information:
Plat Key:
Parcel Number: 45241.2017 Block: 2
SiteAddress: 727 S JERSTAD LN
VERADALE, WA USA 99037
Location:: VER
Zoning: UR -7
Water District:
Area: 15,415 Sq Ft
Nbr of Bldgs: 1
Urban Residential -7
Lot: 17
Owner: Name: GOOD SAMARITAN
Address: 17121 E STII AVE
GREENACRES, WA 99016-8556
Hold: 11
Width: 94 Depth: 113 Right Of Way (ft): 30
Nbr of Dwellings: 1
Review
Review by Utilities
Server Connection Permit
Contractor: UNKNOWN
Address: UNKNOWN
UNKNOWN, WA UNKNOWN
Item Description
SEWER CONNECTION
PROCESSING FEE
Operator: DMD
Firm: UNKNOWN
Phone: (000) 000-0000
Units Unit Desc
1 NUMBER OF
1 Y OR BLANK
Printed By: DMD
Permit Total Fees:
Print Date:
Fee Amount
$85.00
$15.00
$100.00
7/25/2002
Project Number: 02006298
Inv: 1
*Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 7/25/2002
Payment Summary:
Permit Type
Sewer Connection Permit
Page 2 of 2
• .....•,..•.....•.•.•......•.•.•.•.•.•.•.•. • •." "., • '• • •••••....• ....•..• • •• •
Fee Amount Invoice Amount
$100.00 $100.00
$100.00 $100.00
Amount Paid Amount Owing
$0.00 $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.
Sign a tu re:
TC ,a4F11030,tisie wo4
Operator: DMD Printed By: DMD
Print Date: 7/25/2002
US/15/2UU lu:4b r'AA 5u8 3Z6 61Z4 •Iayior Engineering Inc
Lei UUZ/VI/ 4
PROJECT NAME: L& E7 l D(,
PROJECT ENGINEER: P14 56a 1 7-7-,e7Z-
CONTRACTOR: S? O L /A)
SUS CONTRACTOR
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ARRIVAL T4vJE:
DEPARTURE TIME:
08/15/2002 10:47 FAX 509 328 8224
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