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2002, 05-21 Permit App: 02003904 SewerProject Number 02003904 Inv. 1 :Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/21/2002 Page 1 of 2 Project Information: Permit Use: SEWER CONNECTION - EASTON 1 Setbacks: Front Site Information: Plat Key. 001554 Name: MARION ADD District: Lell: Right: Rear: Contact: BAILEY'S CONSTRUCTION Address. E. 3707 28TH C - S - Z: SPOKANE, WA 99223 Phone: (509) 532-0705 Group Name: Project Name: Parcel Number. 45162.1208 Block: Lot. SiteAddress: 11003 E MAXWELL AVE SPOKANE, WA 99206 Location:: SPO Zoning: TFR Water Distract: Arca II Sq Ft Owner: Name: ZUMWOLF, WARREN Address: 11003 E MAXWELL AVE SPOKANE, WA 992116 Hold. ❑ Width 11111 Depth: 131) Right Of Way (ft) 11 Nbr of Bldgs: 0 Nbr of Dwellings. 1 Reriety Information: ., . Review Road Obstruction Permits: t77 -SL( 3 Sewer Connection Permit ContractorBAILEY'S CONSTRUCTION Firm: BAILEY'S CONSTRUCTION Address 3707 E 28TH AVE Phone: (5119) 534-961)5 SPOKANE, WA 99223 Item Description SEWER CONNECTION PROCESSING FEE Units Unit Dcsc 1 NUMBER OF I Y OR BLANK Operator RMB Printed Bv. RIM Fee Amount $85.00 $15.00 Permit Total Fees: $100.00 Print Dale: 5/21/2002 Project Number: 02003904 Inv: 1 Notes: Application THIS IS NOT A_REI MIT Penalties will be assessed for commencing work without a permit Date: 5/21/2002 Page 2 of 2 Payment Suuunanr: . . . Permit Type Sewer Connection Permit Fee Amount Invoice Amount Amount Paid Amount Owing $100.00 $100.00 $100.00 $100.00 50.00 $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 he true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will he complied with. Subsequent issuance of a permit shall not he contrucd 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 RM B Printed By. RMB Print Dale. 5/21/21)1)2