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2002, 06-19 Permit App: 02004950 SewerProject Number: 02004950 Inv: 1 Application Date: 6/19/2002 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 - WELLESLEY MANOR Setbacks: Front Left: Right: Rear: Site Information: ........................................................................................ . Plat Key: 001984 Name: PEPLINSKIS 1ST ADDITION Contact: PERFECTION PLUMBING Address: 5616 W VISTA GRANDE DR C - S - Z: OTIS ORCHARDS, WA 99027 Phone: (509) 921-0275 Group Name: Project Name: District: H Parcel Number: 45011.0603 Block: SiteAddress: 4708 N LILLIAN RD SPOKANE, WA 99216 Location:: SPO Zoning: UNK Water District: Lot: Owner: Name: NORQUIST KEVIN Address: 4708 N LILLIAN RD SPOKANE, WA 99216 Hold: ❑ Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 0 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: :. Review Road Obstruction Released: By• gee. ted-kr.stott "0 'of) 4,i)04k Sewer Connection Permit Contractor: PERFECTION PLUMBING INC Address: 5616 N VISTA GRANDE DR OTIS ORCHARDS WA 99027 Item Description SEWER CONNECTION PROCESSING FEE Finn: PERFECTION PLUMBING INC Phone: (509) 218-8507 Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Fee Amount $85.00 $15.00 Permit Total Fees: $100.00 Operator: RMB Printed By: RMB Print Date: 6/19/2002 Project Number: 02004950 Inv: 1 Application Date: 6/19/2002 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Notes: Payment Summary: Permit Type Sewer Connection Permit Fee Amount Invoice Amount $100.00 $100.00 $100.00 $100.00 Amount Paid Amount Owing $0.00 $100.00 $0.00 $100.00 Page 2 of 2 Disclaimer: Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and fmds 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: RMB Printed By: RMB Print Date: 6/19/2002