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2001, 05-16 Permit App: 01003661 SewerProject Number: 01003661 Inv: 1 d Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/16/01 Page 1 of 1 Project Information: Permit Use: SEWER CONNECTION - WEI LESLEY MANOR Contact: WALDORF CONSTRUCTION Address: PO BOX 840 C - S - Z: NEWMAN LAKE, WA 99025 Setbacks: Front Left: Right: Rear: Phone: (509) 226-2055 Group Name: Site Information: Project Name: Plat Key: 001984 Name: PEPLINSKIS 1ST ADDITION District: H Parcel Number: 45011.0404 SiteAddress. 4621 N LARCH RD SPOKANE, WA 99206 Location:: SPO Zoning: UR -3.5 Water District. Block: Lot: Urban Residential 3.5 Owner: Name: BLYTHE, DAVE Address: 4621 N LARCH RD SPOKANE, WA 99216 Hold: ❑ Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 0 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Department Review ENGINEER Road Obstruction Released By(j,jr� /b—D 5 / � Hold Reasons: 1 Permit Conditions: Permits• Sewer Permit Contractor: WALDORF CONSTRUCTION Firm: RICHARD WALDORF/WALDORF Address: PO BOX 840 Phone: (509) 226-0880 NEWMAN LAKE, WA 99025 Item Description SEWER CONNECTION PROCESSING FEE Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Fee Amount $85.00 $15.00 Permit Total Fees: $100 00 Payment Summary: Operator: MKC Printed By. MKC Print Date: 5/16/01 Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Sewer Permit $100.00 $100.00 $0.00 $100 00 3100.00 $100.00 Notes: „ $0.00 $100.00