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2002, 04-22 Permit App: 02002837 SewerProject Number: 02002837 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 4/22/02 Page 1 of 2 Proiect Information: g.� . ; ...: ,.ag; -..44 ,fr' fid*". . `: °ua,.y:» sz. ., , t er;;; rr. Permit Use: SEWER CONNECTION - HUTCHINSON Contact: VIETZKE EXCAVATING Address: 2011 S CRAIG RD C - S - Z: AIRWAY HEIGHTS, WA 99001 Setbacks: Front Left: Right: Rear: Phone: (509) 244-9607 Group Name: Project Name: Name: MICHENER'S REPLAT Site Information: Plat Key: 001623 Parcel Number: 45181.0612 Block: SiteAddress: 1419 N MESA RD SPOKANE, WA USA 99212 Location:: SPO Zoning: UR -3.5 Water District: Area: 9,690 Sq Ft Nbr of Bldgs: 0 Review Information: Review Road Obstruction Permits: Urban Residential 3.5 Width: 0 Nbr of Dwellings: 0 Contractor: VIETZKE EXCAVATING Address: 2011 S CRAIG RD #1 MEDICAL LAKE, WA 99022 Item Description SEWER CONNECTION PROCESSING FEE Lot: 9 Owner: Name: Address: District: F KADOYA, TOM Y 1419 N MESA RD SPOKANE, WA 99212-2526 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Released By Sewer Connection Permit Units 1 1 Operator: CKF Printed By: CKF Firm: VIETZKE EXCAVATING Phone: (509) 244-9607 Unit Desc NUMBER OF Y OR BLANK Permit Total Fees: Print Date: Fee Amount $85.00 $15.00 $100.00 4/22/02 Project Number: 02002837 Inv: 1 Application THIS IS NOTA PERMIT Penalties will be assessed for commencing work without a permit Date: 4/22/02 Page 2 of 2 Payment Summary: Permit Type Sewer Connection Permit Fee Amount Invoice Amount $100.00 Amount Paid $100.00 $0.00 Amount Owing $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: 4/22/02