2001, 04-23 Permit App: 01002763 SewerProject Number: 01002763 Inv: 1
Application
Date: 4/23/01 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 - DHAENEN'S SQUARE Contact: V.R.S. & ASSOC
PHASE 11 Address: PO BOX 14084
C - S - Z: SPOKANE, WA 99214
Setbacks: Front Left: Right: Rear: Phone: (509) 922-0782
Group Name:
Site Information: Project Name:
Plat Key: 005914 Name: DHAENENS SQUARE PHASE II
District: F
Parcel Number: 45224.43),6 Block: 4 Lot: 1
SiteAddress: 141'3 S MAMER LN Owner: Name: W.R.S. & ASSOC
Spokane, WA USA 99216 Address: PO BOX 14084
Location:. SPO SPOKANE, WA 99214
Zoning: UR -7 Urban Residential -7
Water District: 010 VERA Hold: ❑
Area: 0 Sq Ft Width: 58 Depth: 88 Right Of Way (ft): 30
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information: .
Department Review
UTILITIES Review by Utilities
Hold Reasons.
Permit Conditions:
Released By: _aeri t
Permits:
Sewer Perini,
Contractor: FOLSOM EXCAVATING INC Firm: FOLSOM EXCAVATING
Address: 16701 E VALLEYR'AY AVE Phone: (509) 891-1232
VERADALE, WA 99037
Item Description
SEWER CONNECTION
PROCESSING FEE
Units Unit Desc
1 NUMBER OF
I Y OR BLANK
Fee Amount
$85.00
$15.00
Permit Total Fees: $100.00
Project Number: 01002763 Inv: 1
IL*
Application
Date: 4/23/01 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Payment Summary: -
Operator: CKF Printed By: CKF Print Date: 4/23/01
Pemut Type Fee Amount Invoice Amount Amount Paid Amount Owing
Sewer Permit $100.00 $100.00 $0.00 $100 00
$100.00 $100.00 $0.00 $100.00
Notes: , - -
OK TO ISSUE SEWER PERMITS FOR BLOCK 1 - LOTS 1 TH 10, BLOCK
2 - LOTS 1 TH 12 PER ROGER 10/23/98
DO NOT ISSUE SEWER PERMITS FOR BLOCK 3 - LOTS 1 TH 7, BLOCK
4 - LOTS 1 TH 5, BLOCK 5 - LOTS 1 TH 6
SEWER CONP. ECT `ON PERMIT APPLICATION FORM
PLEASE NOTE: This application form must be filled out accurately and in its entirety, and signed, or a permit will not be issued. Also note
that sewer permits are valid for 12 months form the date of issuance. No extensions will be granted. A separate right-of-way permit is
required for any work performed in or from the county right-of-way.
PROJECT INFORMATION
Job Address:
/1/4? 5or I?<t4-te: Lf,
Parcel Number: Lot: I Block: L7
Project Name:
ULM Name:
Diro.olie ns Sgz.rtre
CHECK APPLICABLE BOXES
0. Regular
O Dry Sewer
O Repair
❑ Addition
❑ Abandonment
O Residential 0 New
O Commercial 0 New
O Temporary
Owner's name: t t_l i S 4 H25So G.
Address: /% / ox ,1/4)<Fy
City/State: SF& kz tZfe / L4JCL
Zip:
Phone:
99.?/v
92;-0-7 P2
* FIRST TIME CONTRACTORS OR HOME OWNERS PERFORMING THE INSTALLATION MUST FIRST CONTACT THE
UTILITIES DIVISION BEFORE PERMIT(S) CAN BE ISSUED.
* SIGNATURE OF UTILITIES DMSION PERSON CONTAL l hD:
CNC. 1c ;55c61 4.23c'/
Contractor(`r,mpany nam:
tc OL'n r --"x VC,4-;nL-1
Sate contractor license number:
Business address:
City/State:
Zip:
Contact Name:
Phone Number:
•
•
•
•
INTERIOR PLUMBING ALTERATIONS? (yes circle one
Fill out the information in the table below if applicable"
Contractor (if different from above):
Business Address:
Phone:
Ciry/Stam/Zip
iphirtee}',-c.'li3kei tJ.,t' nPei!2lt .t4.17vP . t.. +.:,,• S ^{13:L15
FEE INFORMATION
Number of Buildings connecting to sewer 1/ X (times) $100 (per bldg) — $ /00 a 8O
TOTAL FEE
For a single-family residential unit. one permit is required;
For a condonunium, townhouse, duplex, triplex or (ourplcx with separate ownership (as determined by lot lints) separate address and separate stub, one permit is required pct
address pct stub;
For a single building duplex, triplex or fourplex with single ownership, one permit is required
Multiple buildings (apartments, indunrial complexes) with single ownership, one permit required per building connecting to the sewer.
(FOR SITUATIONS NOT COVERED HERE, CALL THE COUNTY DIVISION OF UTILITIES AT 477.3604)
Is any of the work to be performed in or from the county right-of-way? 0 Yes a No
APPLICANT SIGNATURE:
DATE: W9/40.7
Method of Payment:
O Cash 0 Check
0 Visa
0 MasterCard 0 Discover Card
Date: Expires:
Bankcard Number:
Authorized Signature
Spokane County Division of Building & Code Enforcement
1026 West Broadway Avenue " Spokane WA 99260
Tel. No. (509) 477-3675 * Fax No. (509) 477-7198 " TDD No. (509) 477-7133