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2002, 07-19 Permit App: 02006084 SewerProject Number: 02006084 Inv: 1 Application r THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 7/19/2002 Page 1 of 2 Project Information: Permit Use: SEWER CONNECTION - APPLE VALLEY Setbacks: Front Left: Right: Rear: Site Information: ............................................... .............................................. Plat Key: 999999 Name: RANGE ........................................................ . Contact: COURCHAINE CONSTRUCTION Address: 19818 E SPRAGUE C - S - Z: GREENACRES, WA 99016 Phone: (509) 924-5485 Group Name: Project Name: District: Parcel Number: 45213.9062 Block: SiteAddress: 1222 S PIERCE RD SPOKANE, WA 99206 Location:: SPO Zoning: UR -3.5 Water District Urban Residential 3.5 Area: 39,000 Sq Ft Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 1 Review Information:::........................................................... _ ... Lot: Owner: Name: Address: WRIGHT, RANDY 1222 S PIERCE RD SPOKANE, WA 99206 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Review Road Obstruction Permits: n2 lD 51C - Sewer Connection Permit Contractor: COURCHAINE CONSTRUCTION Address: 19818 E SPRAGUE AVE GREENACRES, WA 99016 Item Description SEWER CONNECTION PROCESSING FEE Firm: COURCHAINE CONSTRUCTION Phone: Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Operator: DMD Printed By: DMD Permit Total Fees: (509) 928-0846 Fee Amount $85.00 $15.00 $100.00 Print Date: 7/19/2002 Project Number: 02006084 Inv: 1 - Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 7/19/2002 Page 2 of 2 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 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: DMD Printed By: DMD Print Date: 7/19/2002