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2001, 12-27 Permit App: 01011067 SewerProject Number: 01011067 Inv: 1 Appication Date: 12/27/01 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Proiect Information: Permit Use: SEWER CONNECTION - SP -1271-01 PARCEL C Setbacks: Front Left: Right: Rear: Site Information: Plat Key: 006200 Name: SP -1271-01 Parcel Number: 45261.1633 Block: Contact: FOLSOM EXCAVATING Address: 16701 E VALLEYWAY C - S - Z: VERADALE WA 99037 Phone: (509) 891-1232 Group Name: Project Name: District: F SiteAddress: 2308 S MARCUS LN VERADALE, WA USA 99037 Location:: VER Zoning: UR -3.5 Urban Residential 3.5 Water District: 010 VERA Area: 14,554 Sq Ft Nbr of Bldgs: 1 Width: 0 Nbr of Dwellings: 1 Review Information: Lot: C Owner: Name: DIAMOND ROCK CONSTRUCTIO Address: 15706 E VALLEYWAY VERADALE WA 99037 Hold: ā‘ Depth: 0 Right Of Way (ft): 20 Review Review by Utilities Permits: Contractor: Address: FOLSOM EXCAVATING INC 16701 E VALLEYWAY AVE VERADALE, WA 99037 Item Description SEWER CONNECTION PROCESSING FEE Operator: JAS Printed By: Sewer Connection Permit Units 1 1 Firm: FOLSOM EXCAVATING Phone: Unit Desc NUMBER OF Y OR BLANK Permit Total Fees: (509) 891-1232 Print Date: Fee Amount $85.00 $15.00 $100.00 Project Number: 01011067 Notes: Inv: 1 App ietitic}n— THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 12/27/01 Page 2 of 2 Payment Summary: Permit Type Sewer Connection Permit Fee Amount Invoice Amount Amount Paid Amount Owing $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: JAS Printed By: Print Date: