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2001, 11-08 Permit App: 01009937 SewerProject Number: 01009937 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 11/8/01 Page 1 of 2 Project Information: Permit Use: SEWER CONNECTION - SHELLEY LAKE Setbacks: Front Left: Site Information: Right: Rear: Plat Key: 005862 Name: SHELLEY LAKE Contact: MCKINLEY, BRUCE Address: 12911 E SANSON AVE C - S - Z: SPOKANE, WA 99216 Phone: (509) 290-1047 Group Name: Project Name: District: F Parcel Number: 45242.1717 Block: 7 SiteAddress: 521 S SONORA LN VERADALE, WA USA 99037 Location:: VER Zoning: UR -3.5 Water District: Area: 7,633 Sq Ft Nbr of Bldgs: 1 Urban Residential 3.5 Width: 61 Nbr of Dwellings: 1 Lot: 17 Owner: Name: MCKINLEY, BRUCE Address: 12911 E SANSON AVE SPOKANE, WA 99216 Hold: ❑ Depth: 115 Right Of Way (ft): 30 Review Information: Review Review by Utilities Permits: Sewer Connection Permit Contractor: A & D CONST. & EXCAVATION Address: 22513 E DALKE RD OTIS ORCHARDS, WA 99027 Item Description SEWER CONNECTION PROCESSING FEE Operator: CKF Firm: A & D CONSTRUCTION Phone: (509) 928-2621 Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Printed By: CKF Permit Total Fees: Fee Amount $85.00 $15.00 $100.00 Print Date: 1118101 Project Number: 01009937 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 11/8/01 Page 2 of 2 Notes: �M ANOMMUMMNSANIM OCCUPANCY IS DENIED ON ALL LOTS UNTIL FURTHER NOTICE FROM DIV. OF UTILITIES PER GENE REPP 3/26/97 CKF OK TO ISSUE SEWER PERMITS FOR: BLOCK 2 - LOTS 3 THROUGH 10 & 1, 2 BLOCK 3 - LOTS 1 THROUGH 7 BLOCK 4 - LOTS 1 THROUGH 4 BLOCK 5 - LOTS 2 THROUGH 6 & 19 BLOCK 6 - LOTS 1 THROUGH 10 Payment Summary: Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Sewer Connection Permit $100.00 $100.00 $0.00 $100.00 $100.00 $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: 11/8/01