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2002, 01-18 Permit App: 02000321 SewerProject Number: 02000321 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 1/18/02 Page 1 of 2 Project Information: Permit Use: DRYLINE SEWER CONNECTION / SP -1267-01 Setbacks: Front Left: Right: Rear: Site Information: Plat Key: 006193 Name: SP -1267-01 Contact: ROGER GIDDINGS EXCAVATION Address: 11812 E. BIGELOW GULCH C - S - Z: SPOKANE, WA. 99217 Phone: (509) 922-5907 Group Name: Project Name: District: F Parcel Number: 45161.0638PTN Block: SiteAddress: 11716 E SINTO AVE SPOKANE, WA USA 99206 Location:: SPO Zoning: UR -3.5 Urban Residential 3.5 Water District: 011 MODERN Area: 17,723 Sq Ft Width: 0 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Review Review by Utilities Permits: Lot: B Owner: Name: CURRY, GORDON Address: 14313 E TRENT SPOKANE, WA 99216 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Oleio1 e --LL V fL-v.t..t NC +' YE.g-M Contractor: ROGER GIDDING Address: 11812 E BIGELOW GULCH RD SPOKANE, WA 99207 Sewer Connection Permit Finn: ROGER GIDDINGS EXCAVATION Phone: (509) 922-5907 Item Description Units Unit Desc Fee Amount SEWER CONNECTION 1 NUMBER OF $85.00 PROCESSING FEE 1 Y OR BLANK $15.00 Operator: CKF Printed By: CKF Permit Total Fees: $100.00 Print Date: 1/18/02 Project Number: 02000321 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 1/18/02 Page 2 of 2 Notes: Payment Summarv: Permit Type Sewer Connection Permit Fee Amount Invoice Amount $100.00 $100.00 $100.00 $100.00 Amount Paid $0.00 Amount Owing $100.00 $0.00 $100.00 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: CKF Printed By: CKF Print Date: 1/18/02