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2002, 06-17 Permit App: 02004851 SewerProject Number: 02004851 Inv: 1 Application Date: 6/17/02 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SEWER CONNECTION - MIDILOME EAST 3RD Contact CLIFF SCHMITZ CONSTRUCTION Address: 16520 E SECRETARIAT C - S - Z: VERADALE. WA 99037 Setbacks: Front Left: Right: Rear: Phone: (509) 444-7733 Group Name: Site Information: Project Name: Plat Key. 006185 Name: MIDILOME EAST 3RD - District: F Parcel Number: 45341.1802 Block: 4 SiteAddress: 3421 S MCDONALD ST SPOKANE, WA USA 00000 Location:: SPO Lot 2 Owner: Name: CLIFF SCHMITZ CONSTRUCTION Address: 16520 E SECRETARIAT VERADALE, WA 99037 Zoning. UR -3.5 Urban Residential 3.5 Water District Hold: ❑ Area: 1,539.00 Acres Width: 109 Depth: 125 Right Of Way (ft): 50 Nbr of 13Idgs: 1 Nbr of Dwellings: 1 Review Information: , Review Review by Utilities Permits: Released By: Ot FOJ 7 czar Server Connection Permit Contractor: FOLSOM EXCAVATING INC Firm: FOLSOM EXCAVATING Address. 16701 E VALLEYWAY AVE VERADALE, WA 99037 Item Description SEWER CONNECTION PROCESSING FEE Phone: (509) 891-1232 Units Unit Desc 1 NUMBER OF I Y OR I3LANK Operator: CKF Printed By. CKF Permit Total Fees: Fee Amount $85 00 $15 00 5100 00 Print Date: 6/17/02 Project Number: 02004851 Inv: / Application t Date: 6/17/02 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Notes: - Payment Summary: , - - Permit Type Fee Amount Invoice Amount Amount Paid Amount Owinu Sewer Connection Permit $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 persons) 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 13y: CKF Print Date: 6/17/02