1999, 06-04 Permit App: 99004931 SewerProject Number: 99004931 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 6/4/99 Page 1 of 1
Proiect Information:
.::::::::::: ......................... .
Permit Use: SEWER CONNECTION / SHELLEY LAKE 2ND
Setbacks: Front Left: Right: Rear:
Site Information:
Plat Key: 005977 Name: SHELLEY LAKE SECOND ADDI
Contact: NOR -WEST DEVELOPMENT
Address: 3223 N MARKET ST
C - S - Z SPOKANE, WA. 99207
Phone: (509) 484-4090
District:
Parcel Number: 45241.9027
SiteAddress: 715 S SHELLEY LAKE LN
GREENACRES, WA USA 99
Location:: GRE
Zoning: UR -3.5 Urban Residential 3.5
Water District: 010 VERA
Area: 11,600 Sq Ft Width: 0
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Owner: Name: NOR -WEST DEVELOPMENT I
Address: 3223 N MARKET ST
SPOKANE, WA. 99207
Hold: 0
Depth: 0 Right Of Way (ft): 30
Department
UTILITIES
Permits:
Review
Review by Utilities
Comments: ��Y�/,C/C ,/c) y L' Ver..a.r/,e/T .ST•P,"7-
GA' 17.1' .(./7- Peic To imT
Sewer Permit
Contractor: NOR -WEST CONSTRUCTION
Address: 3223 N MARKET
SPOKANE, WA 99207
Item Description
SEWER CONNECTION
PROCESSING FEE
Payment Summary:
Operator: JDL
Permit Type
Sewer Permit
Notes:
Finn: NOR -WEST CONSTRUCTION
Phone: (509) 484-4090
Units Unit Desc
1 NUMBER OF
1 Y OR BLANK
Permit Total Fees:
Fee Amount
$85.00
$15.00
$100.00
Printed By: JDL Print Date: 6/4/99
Fee Amount Invoice Amount Amount Paid Amount Owing
$100.00 $100.00
$100.00
$100.00
$0.00 $100.00
$0.00
$100.00
SPOK A N E
UTILITIES DIVISION •
N. Bruce Rawls. P.E., Utilities Director
C O U N T
A DIVISION OF THE PUBLIC WORKS DEPARTMENT
GENERAL FACILITIES CHARGE (GFC)
PAYMENT OPTION SELECTION RECORD
1'- �i
Date: '--� Parcel No(s):
Site Address(es):
!/
/-2'r1Aksi r-t.MLO CO OR Owner Name:
Budder Name:,
- 5f/ 9 7
Payment Option Selected (Check One):
1. (�FC payment received at issuance of Sewer Connection Permit by
Division cf Utilities
1.0- ) "To 64.p0.,c‘cs.:3C n�.
2. ( ) GFC payment in 24 equal monthly payments upon establishment cf Sewer Billing Account.
Complete one of the following statements.
a. Owner's Statement: I, understand that I will
be billed for the applicable GFC amount in 24 monthly installments. The monthly GFC
installments will be added to my monthly sewer service charges.
Owners Signature Date
b. Builder's Statement: I, understand that
because I am selecting this option for payment of the GFC, that the purchaser cf the home will
be responsible for payment of the applicable GFC in 24 equal mcnt� �iy installments. I agree to
formally disclose to potential buyers of the property that the GFC charges will be added to the
monthly sewer se^nce billings as soon as b.illing comments.
Builders Authorized Representative's Signature
Spokane County,
Division of Utilities
10_6 W. Broadway • Spokane, WA 99'_60-0150 • (509) 477-3604 FAX: (509) 477-4715 TDD: (509) 324-3166
///4f�
Date
GFC Payment Option Form
Revised 1/26/99