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2002, 07-15 Permit App: 02005865 SewerProject Number: 02005865 Im• 1 Application THIS IS NOT A PERMIT Date 7/15/02 Page 1 of 2 Penalties will be assessed for commencing work without a permit Project Information: Permit Use: DRYLINE SEWER CONNECTION Contact: 7 -BEST CONSTRUCTION Address: PO BOX 13421 C - S - Z: SI'OKANE. WA. 99213 Setbacks: Front Left: Right: Rear: Phone: (509) 891-9949 Group Name: Site Information: Project Name: Plat Key: 000647 Name: DORA'S SUB. Parcel Number 35124.0203 Block: SiteAddress: 6919 E NIANSFIEI,D AVE SPOKANE. WA 99212 Location:: SPO Zoning: UR -3.5 Water District: Urban Residential 3.5 District- E Lot: Owner: Name: MATTERN, FLOYD Address: 6919 E MANSFIELD AVE SPOKANE, WA 99212 Hold: ❑ Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 40 Nbr of Bldgs: 2 Nbr of Dwellings: 1 Review Information: Review Road Obstruction Review by Utilities Permits: Contractor: Z BEST CONSTRUCTION Address P 0 BOX 13241 AVE SPOKANE, WA 99213-3241 Item Description SE\VER CONNECTION PROCESSING FEE Released By: at -t--1--1 -o 2 Released By: 494l.) Sewer Connection Permit Fn in: 7 BEST CONSTRUCTION Phone: (509) 891-9949 Units Unit nese 1 NUMBER OF 1 Y OR BLANK Operator: CKF Printed 13y. CKF Fee Amount $85.00 $15.00 Permit 'Total Fees: $100.00 Print Date: 7/15/02 Project Number: 02005865 Inc: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 7/15/02 Page 2 of 2 Notes: , _ Payment Summon,: , 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: CKF Printed By: CKF Print Date: 7/15/02