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2002, 05-28 Permit App: 02004134 Plumbing Fixtures, ROW, SewerProject Number: 02004134 Inv: 1 A ., li.,aiion Date: 5/28/2002 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: .::.:::::,::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.:............................................................................................. . Permit Use: SEWER CONNECTION - HUTCHINSON Contact: SHORT SEPTIC SERVICE INC Address: 3350 WILLIAMS RD E C - S - Z: ALMIRA WA 99103 Setbacks: Front Left: Right: Rear: Phone: (509) 639-2393 Group Name: Site Information: Project Name: Plat Key: 001288 Name: HUTCHINSON'S ADD District: F Parcel Number: 45181.0312 Block: SiteAddress: 8704 E SINTO AVE SPOKANE, WA 99212 Location:: SPO Zoning: UR -3.5 Urban Residential 3.5 Water District: Lot: Owner: Name: POTTER, PATRICK Address: 8704 E SINTO AVE SPOKANE, WA 99212 Hold: ❑ Area: 0 Sq Ft Width: 124 Depth: 200 Right Of Way (ft): 50 Nbr of Bldgs: 2 Nbr of Dwellings: 1 Review Information: Review Road Obstruction Oaslr0�� Permits: Released By: Contractor: SHORT SEPTIC SERVICE INC Address: 3350 WILLIAMS RD E ALMIRA WA 99103 Item Description SEWER CONNECTION PROCESSING FEE Sewer Connection Permit Firm: SHORT SEPTIC SERVICE INC Phone: (509) 639-2393 Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Operator: RMB Printed By: RMB Fee Amount $85.00 $15.00 Permit Total Fees: $100.00 Print Date: 5/28/2002 Project Number: 02004134 Inv: 1 Application Date: 5/28/2002 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Notes: ........ . Payment Summary::»<:;>:;;::;::;::; Permit Type Sewer Connection Permit Disclaimer: Fee Amount Invoice Amount Amount Paid Amount Owing $100.00 $100.00 $0.00 $100.00 $100.00 $100.00 $0.00 $1 Ili 1. 00 Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examine . and fmds 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: RMB Printed By: RMB Print Date: 5/28/2002