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2001, 12-26 Permit App: 01011033 SewerProject Number: 01011033 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SEWER CONNECTION - HARRINGTON Date: 12/26/2001 Page 1 of 2 Setbacks: Front Left: Right: Rear: Site Information: Plat Key: 000000 Name: UNKNOWN Contact: GOBER & SON Address: 11215 E TRENT AVE C - S - Z: SPOKANE, WA 99206 Phone: (509) 924-5372 Group Name: Project Name: ................. District: F Parcel Number: 45184.0750 Block: SiteAddress: 525 N MARQUERITE RD SPOKANE, WA USA 00000 Location:: SPO Zoning: UR -3.5 Water District Area: 14,983 Sq Ft Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: ::......................................... Urban Residential 3.5 Lot: Owner: Name: FISCAL DYNAMICS Address: 3620 BRIDGPORT WAY W UNIVERSITY PLACE, WA 98466 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Review Review by Utilities Permits: Contractor: GOBER & SON & SON Address: 11215 E TRENT SPOKANE, WA 99206-4696 Item Description SEWER CONNECTION PROCESSING FEE c Sewer Connection Permit u -j /y2'% Firm: GOBER & SON & SON Phone: (509) 924-5372 Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Fee Amount $85.00 $15.00 Permit Total Fees: $100.00 Operator: DMD Printed By: DMD Print Date: 12/26/2001 Project Number: 01011033 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 12/26/2001 Page 2 of 2 Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Sewer Connection Permit $100.00 $100.00 $100.00 $0.00 $100.00 $100.00 $100.00 $0.00 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: 12/26/2001