1994, 06-13 Permit App: 94005418 SewerPROJECT NUMBER= 94005418 APPLICATION DATE= 06/13/94 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
----------------------------------------------------------------------
SITE STREET= 212 S PROGRESS RD
ADDRESS= VERADALE WA 99037
PARCEL#= 45231.0751
PERMIT USE= SEWET CONNECTION (94S-655) ST. MARY ADD
PLAT#= CONVRT PLAT NAME= CONVERTED CNTY DATA
BLOCK= LOT= ZONE= AGRI DIST#= E
AREA= 00000000 F/A= F WIDTH= DEPTH= R/W=
# OF BLDGS= 3 # DWELLINGS= 1 WATER DIST = .
OWNER= RIDER, SCOTT E PHONE= 509 928 0782
STREET= 212 S PROGRESS RD
ADDRESS= VERADALE WA 99037
CONTACT NAME= Z -BEST CONSTRUCTION PHONE NUMBER= 509 891 9949
BUILDING SETBACKS: FRONT= NA LEFT= NA RIGHT= NA REAR= NA
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
------------------------------------------------------------------------- �
UTILITIES CONNECTION AGREEMENT REQUIRED DO � z SSI -Ag .5i&J- ��C� 6201
COMMENTS:
***************************** SEWER PERMIT ******************************
CONTRACTOR= Z BEST CONSTRUCTION PHONE= 509 891 9949
STREET= 7816 E BROADWAY AVE
ADDRESS= SPOKANE WA 99212
ITEM DESCRIPTION QUANTITY FEE AMOUNT
------------------------- -------- ----------
PROCESSING FEE Y 10.00
SEWER CONNECTION 1 40.00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
--------------- ------------- ------------ -------------
SEWER PERMIT 50.00 .00 50.00
------------- ------------ -------------
50.00 .00 50.00
PROCESSED BY: DAWN DOMPIER
PRINTED BY: DAWN DOMPIER
******************************** 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)
JOB ADDRESS: pc (_ 'C. S _ PARCEL NUMBER:
lj
CITY: � � Cly h."c-- STATE: ZIP CODE : 67q-)-o-(o
('
OWNER NAME: 4-50 p 1 d Yp_ r _ ADDRESS : c9 -___t Q �DC oo co j
CITY: G�Dr) bet 0;.() _ STATE: Uk,)OL ZIP CODE: -9 q Co
PHONE NUMBER:
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO
(CIRCLE 0
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: ' . P S % ('-O�)z2- LA r-h'of) ADDRESS: 4vJGt,�I
CITY: STATE: STATE: WA ZIP CODE: cIQ 211
PHONE NUMBER:
STATE CONTRACTORS LICENSE NUMBER: 46 r_4T7 C. � r? ,
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE)
INTERIOR ALTERATION BY : �7' B i? `->-E
ADDRESS: -7 LP c od A t ID a -k I PHONE NUMBER: 2 ct - 9q q q
CITY: . �-)Jonk ",e STATE:ZIP CODE: cl gat
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION ............:#I OF BUI7jDINGS , X 50.00 = !S b -S
INTERIOR PLUMBING ALTERATIONS:# OF BUI',DINGS l X 35.00 = gl-
TO'.^AL PERMIT FEE DUE $ RAS Q�
APPLICANT
SIGNATURE:
DATE: "�) - a -q L -
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKAYE, WA. 99260 (509) 456-3675
.co