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2001, 08-23 Permit App: 01007167 Sewer Project Number: 01007167 Inv: 1 Application Date: 8/23/2001 Page 1 of 1 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SEWER CONNECTION-WELLESLEY MANOR Contact: VIETZKE EXCAVATING Address: 2011 S CRAIG RD C-S-Z: MEDICAL LAKE,WA.99022 Setbacks: Front Left: Right: Rear: Phone: (509)535-4814 Group Name: Site Information: Project Name: Plat Key: 002848 Name: WELLESLEY MANOR 2ND ADD District: H Parcel Number: 45012.2504 Block: Lot: SiteAddress: 16021 E RICH AVE Owner:Name: STANDOW,RANDY SPOKANE,WA 99216 Address: 16021 E RICH Location::SPO SPOKANE,WA 99216 Zoning: UR-3.5 Urban Residential 3.5 Water District: Hold: ❑ Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review In ormation: :. f Department Review ENGINEER Road Obstruction Released By: 5' y-- i I Hold Reasons: t Permit Conditions: of S.6 a gam Permits: Sewer Connection Permit Contractor: VIETZKE EXCAVATING Firm: VIETZKE EXCAVATING Address: 2011 S CRAIG RD#1 Phone: (509)244-9607 MEDICAL LAKE,WA 99022 Item Description Units Unit Desc Fee Amount SEWER CONNECTION 1 NUMBER OF $85.00 PROCESSING FEE 1 Y OR BLANK $15.00 Permit Total Fees: $100.00 Pame t n umma v S rv• Operator: MKC Printed By: MKC Print Date: 8/23/2001 Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Sewer Connection Permit $100.00 $100.00 $0.00 $100.00 $100.00 $100.00 $0.00 $100.00 Notes: :::..::::::::::::::::::::::::..::::::::::::::::::::......................:..,............._...._.....................................................:::::::::::......::::::::::::::.::.::::.................................................................