2000, 12-14 Permit App: 00011186 SewerProject Number: 00011186 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 12/14/00 Page 1 of 2
Project Information:
Permit Use: SEWER CONNECTION - SHELLEY LAKE 1ST
Setbacks: Front
Site Information:
Left: Right: Rear:
Contact: LEXINGTON HOMES
Address: 12218 NEZ PERCE LN
C - S - Z: SPOKANE WA 99206
Phone: (509) 924-1519
Group Name:
Project Name:
Plat Key: 005947 Name: SHELLEY LAKE 1ST ADDITION
District: F
Parcel Number: 45241.1823 Block: 1
SiteAddress: 355 S SHELLEY LAKE LN
VERADALE, WA USA 9903
Location:: VER
Zoning: UR -3.5
Water District:
Area: 8,338 Sq Ft
Nbr of Bldgs: 1
Review Information:
Urban Residential 3.5
Width: 59
Nbr of Dwellings: 1
Lot: 23
Owner: Name: LEXINGTON HOMES
Address: 12218 E NEZ PERCE LN
SPOKANE, WA 99206
Hold: ❑
Depth: 108 Right Of Way (ft): 30
Department
UTILITIES
Hold Reasons:
Permit Conditions:
Review
Review by Utilities
Released, By:
Contractor: LEXINGTON HOMES
Address: 12218 E NEZ PERCE LN
SPOKANE, WA 99206
Item Description
SEWER CONNECTION
PROCESSING FEE
Sewer Permit
1
Firm: LEXINGTON HOMES
Phone: (509) 922-9870
Units Unit Desc
1 NUMBER OF
1 Y OR BLANK
Permit Total Fees:
Fee Amount
$85.00
$15.00
$100.00
Project Number: 00011186 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Payment Summary
Date: 12/14/00 Page 2 of 2
Operator: RMB
Permit Type
Sewer Permit
Notes:
Printed By: RMB
Print Date:
12/14/00
Fee Amount Invoice Amount Amount Paid Amount Owing
$100.00 $100.00 $0.00 $100.00
$100.00
$100.00
DO NOT ISSUE SEWER PERMIT - OK TO ISSUE HOUSE PER ROGER
10/27/98
OK TO ISSUE SEWER PERMITS FOR:
BLK4-L 1 BLK5-L2,16,18
BLK6-L 1,3,5,6,9,10 BLK7-L 1,2
$0.00
$100.00
' Spokane County Division of Utilities
SEWER CONNECTION PERMIT
APPLICATION FORM
PLEASE NOTE: This application form must be filled out accurately and in its entirety, and signed, or a permit will not be issued.
Also note that sewer permits are valid for 12 months from the date of issuance. No extensions will be granted.
PROJECT INFORMATION
Dry Line
Sewer? (YIN)
Parcelnumber (f known):
11% le013
First-time contractors or home -owners performing the installation must first contact the utilities department (in person or via phone
[456-3604]) before a permit can be issued.
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Owner's name:
n.)fq?�� MES, /.
City/State: S)Ri,c , GOA
Zip: '9 -" co
Phone: (s59) 924-
-15/9
Contractor (company name):
Business address:
Flo '7 / (
City/State: (2E,e/).E- Gtr
Zip: 9 9. 37 Phonee,9) 8 9/ —/Z32 -
State contractor license number:
a 33 DLL
Contact Name:
Phone: (5 09) 9 "2—(aa
INTERIOR PLUMBING ALTERATIONS? (yes/no) circle ono
Fill out the information in the table below if applicable**
Contractor (if different from above): Phone:
City/State/Zip:
Business Address:
plunrbrng reversal fee rnformahan; gee reverse sl
ttf thrz fo•
rm.
FEE INFORMATION
Sewer Connection: Number of Buildings / X(tirnes) $100 (per bldg) _ $ /CO ag
TOTAL FEE
• For a single-family residential unit, one permit is required;
•• For a condominium, townhouse, duplex, triplex or fourplex with separate ownership (as determined by lot lines) separate
address and separate stub, one permit is required per address per stub;
• For a single building duplex, triplex or fourpl single ownership, one permit is required
• Multiple buildings (apartments, indu.strial co>j ) with single ownership, one permit required per building connecting to
the sewer.
(For situations not co 4(b here, call the County Division of Utilities @ 456-3604)
APPLICANT SIGNATURE:
Date:
Return to:
Spokane County Disunion of Building ter Planning
West 1026 Broadway Avenue * Spokane, Washington 99260
PHONE: (509) 456-3675 * FAX (509) 324-3198 * TDD: (509) 324-3166
Spokane County does not dtsmmnw on the bans o(dtaabdtq m the dmaao'to, of oesttnent of employment win ptogmn of acd.itiea
n/s4M a\emee.n••+ee•