2001, 04-24 Permit App: 01002818 SewerProject Number: 01002818 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 4/24/01 Page 1 of 2
Project Information:
FIRSEMEMENAMMOMIMMIXAMMIrMe
Permit Use: SEWER CONNECTION - SHELLEY LAKE
Setbacks: Front
Left: Right: Rear:
Site Information:
Plat Key: 005862 Name: SHELLEY LAKE
Contact: LANZCE G DOUGLASS INC
Address: 815 E ROSEWOOD AVE
C - S - Z: SPOKANE, WA 99208
Phone: (509) 483-6532
Group Name:
Project Name:
District: F
Parcel Number: 45242.1508 Block: 5
Lot: 8
SiteAddress: 522 S SONORA LN Owner: Name: LANZCE G DOUGLASS INC
VERADALE, WA USA 99037 Address: 815 E ROSEWOOD AVE
Location:: VER SPOKANE, WA 99208
Zoning: UR -3.5
Water District:
Urban Residential 3.5
Hold: ❑
Area: 8,552 Sq Ft Width: 78 Depth: 115 Right Of Way (ft): 30
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Department
UTILIT ► S
H d easons:
Permitnditions:
Permits:
Review
Review by Utilities
Contractor: CANNON EXCAVATING INC
Address: PO BOX 28778
SPOKANE, WA 99228
Item Description
SEWER CONNECTION
PROCESSING FEE
Sewer Permit
Firm: CANNON EXCAVATING INC
Phone: (509) 467-6522
Units Unit Desc
1 NUMBER OF
1 Y OR BLANK
Fee Amount
$85.00
$15.00
Permit Total Fees: $100.00
Project Number: 01002818 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Payment Summary:
Operator: CKF
Permit Type
Sewer Permit
Date: 4/24/01 Page 2 of 2
Printed By: CKF
Print Date: 4/24/01
Fee Amount Invoice Amount Amount Paid Amount Owing
$100.00 $100.00
$0.00 $100.00
$100.00
$100.00
Notes:
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
$0.00
$100.00
Spokane County Division of Utilities
SEWER CONNECTION PERMIT
APPLICATION FORM
PLEASE NOTE: This application form must be filled out accurately and in its entirety, and signed, or a permit will not be issued.
Also note that sewer permits are valid for 12 months from the date of issuance. No extensions will be granted.
PROJECT INFORMATION
Job address:
City: Spokane , WA
Zip:
Parcel number(fknown):
Dry Line
Sewer? (Y/N)
Owner's name:
Lanzce G. Douglass, Inc.
City/State: Spokane , WA
Zip: 9A2ng
Phone:
509-483-6532
First-time contractors or home -owners performing the installation must first contact the utilities department (in person or via phone
[456-3604]) before a permit can be issued _
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Contractor (company name):
Cannon Excavating
State contractor license number:
CANNO**10201
Business address:
P.O. Box 28778
City/State: Spokane , WA
Zip99208-8778 Phone: 509-467-6522
Contact Name:
Kurt Cannon
Phone: 994-3013
INTERIOR PLUMBING ALTERATIONS? (yes/no) goon.
Fill out the information in the table below if applicable"
Contractor (if different from above): Phone:
Business Address:
City/State/Zip:
**:. g f .. m rmattow ,reversm e_vf'tlns
or rn . rer+ersa! ee:
FEE INFORMATION
Sewer Connection: Number of Buildings X (ti) $100 (per bldg) = $
TOTAL FEE
• For a single-family residential unit, one permit is required;
• For a condominium, townhouse, duplex, triplet or fouiplex with separate ownership (as determined by lot lines) separate
address and separate stub, one permit is required per address per stub;
• For a single building duplex; triplex or fourplex with single ownership, one permit is required
• Multiple buildings (apartments, industrial complexes) with single ownership, one permit required per building connecting to
the sewer.
(For situations not covered here, call the County Division of Utilities ® 456-3604)
APPLICANT SIGNATURE: % � /% / -i Date: 1-4-2-1'i
Return co:
Spokane Candy Dairioa of Bulking & Planning
(West 1026 Broadway Avenue ue * Spore, Washington 99260
PHONE (509) 456-3675 x FAX (509) 324-3198 * TDD: (509) 324-3166
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