1993, 06-24 Permit App: 93005112 SewerPROJECT NUMBER= 93005112 APPLICATION DATE= 06/24/93 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 3612 S MERCY CT
ADDRESS= SPOKANE WA 99206
PERMIT USE= SEWER CONNECTION -
PLAT#=
BLOCK=
AREA=
# OF BLDGS=
OWNER=
STREET=
ADDRESS=
002092 PLAT NAME=
2 LOT=
00000000 F/A=
1 # DWELLINGS=
SMITH, GARY
3612 S MERCY CT
SPOKANE WA 99206
PARCEL#= 45321.1607
PONDEROSA (93S-442)
PONDEROSA 3RD ADD
7 ZONE= SFR
F WIDTH=
1 WATER DIST
PHONE=
DIST#=
DEPTH=
E
R/W= 50
509 928 4557
CONTACT NAME= GARY SMITH PHONE NUMBER= 509 928 4557
BUILDING SETBACKS: FRONT= N/A LEFT= N/A RIGHT= N/A REAR= N/A
****************************** REVIEW INFORMATION ***************************
DEPARTMENT
REVIEW REQUIREMENT
UTILITIES CONNECTION AGREEMENT REQUIREDE
COMMENTS: Oki t SSUt CAWJA
***************************** SEWER PERMIT
CONTRACTOR= OWNER
ITEM DESCRIPTION
PROCESSING FEE
SEWER CONNECTION
PERMIT TYPE FEE AMOUNT
SEWER PERMIT
50.00
50.00
PROCESSED BY: CAROL BRADBURN
PRINTED BY: CAROL BRADBURN
6,14 5
************.*****************
PHONE=
QUANTITY FEE AMOUNT
Y
1
10.00
40.00
AMOUNT PAID AMOUNT OWING
.00
.00
50.00
50.00
******************************** THANK YOU **********************************
**
**
SEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY
AND SIGNED OR PERMIT WILL NOT BE ISSUED.
(IF KNOWN) '' II✓7
JOB ADDRESS: -3,610: 5 . M r- 2. �� CT PARCEL NUMBER : `t S 3 -1 /
CITY: Po,Nz STATE:
WA ZIP CODE: (19 206
OWNER NAME: (3AR\I
CITY: pol(a
7 -1.\ --
CITY :
-i
STATE:
ADDRESS:
(AA
6/ Z
CT.
PHONE:
S 57
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION?
NO
CLE ONE)
*IF PROPERTY OWNER
CONSTRUCTIONINSTALLING
REQUIREMENTS BEFOREFIRST
PERMICONTACT
UTILITIES
DEPARTMENT FOR ISSUEQ
CONTRACTOR:
CITY: STATE: PHONE:
STATE CONTRACTORS LICENSE NUMBER..
UTILITIES INSTALLERS PERMIT NUMBER:
ADDRESS:
INTERIOR PLUMBING ALTERATIONS? YES (CIRCLE ONE)
INTERIOR ALTERATION WORK BY..:
ADDRESS: PHONE:
CITY: STATE: ZIP CODE:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC
THAT WILL BE CONNECTED TO THE SEWER.
SEWER CONNECTION # OF BUILDINGS X 50.00 =
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $
APPLICANT
SIGNATURE
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675