2002, 04-05 Permit App: 02002266 SewerProject Number: 02002266 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 4/5/2002 Page 1 of 2
Project Information:
Permit Use: SEWER CONNECTION - SHELLEY LAKE 3RD
Setbacks: Front
Site Information:
Plat Key: 006156 Name: SHELLEY LAKE 3RD ADDITION
Left: Right: Rear:
Contact: GEORGE H WHITE INC
Address: PO BOX 52
C - S - Z: LIBERTY LAKE, WA 99019
Phone: (509) 921-9752
Group Name:
Project Name:
District: F
Parcel Number: 45241.2604 Block: 1
SiteAddress: 845 S SHELLEY LAKE LN
VERADALE, WA USA 99037
Location:: VER
Zoning: UR -3.5
Water District:
Urban Residential 3.5
Lot: 4
Owner: Name: GEORGE H WHITE INC
Address: PO BOX 52
LIBERTY LAKE, WA 99019
Hold: ❑
Area: 18,176 Sq Ft Width: 80 Depth: 202 Right Of Way (ft): 30
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Review by Utilities
Permits:
4/g
Released
GFC Foie -/n 164)&;,0,
Contractor: GEORGE H WHITE CONST
Address: 0 BOX 52
LIBERTY LAKE, WA 99019
Item Description
SEWER CONNECTION
PROCESSING FEE
Sewer Connection Permit
Firm: GEORGE HARVARD WHITE CON
Phone: (509) 921-9752
Units Unit Desc
1 NUMBER OF
1 Y OR BLANK
Operator: DMD Printed By: DMD
Fee Amount
$85.00
$15.00
Permit Total Fees: $100.00
Print Date: 4/5/2002
Project Number: 02002266 Inv: 1 Application Date: 4/5/2002
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes: .< _..
Payment Summary
Permit Type
Sewer Connection Permit
Fee Amount Invoice Amount Amount Paid Amount Owing
$100.00 $100.00 $0.00 $100.00
$100.00 $100.00 $0.00 $100.00
Page 2 of 2
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: 4/5/2002