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2002, 05-28 Permit App: 02004122 SewerProject Number: 02004122 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/28/02 Page 1 of 2 Project Information: Permit Use: SEWER CONNECTION - SOUTH PONDEROSA Setbacks: Front Site Information: Left: Right: Rear: Plat Key: 000875 Name: FOREST MEADOW ADD Contact: INLAND EMPIRE EXCAVATION Address: 10211 E. DRIFTWOOD C - S - Z: SPOKANE, WA 99206 Phone: (509) 891-1586 Group Name: Project Name: District: E Parcel Number: 45333.0205 Block: SiteAddress: 4145 S SUNDOWN DR SPOKANE, WA 99206 Location:: SPO Zoning: UNKN Unknown Water District: Lot: Owner: Name: LENTZ, TOM Address: 4145 S SUNDOWN DR SPOKANE, WA 99206 Hold: ❑ Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 60 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Review Road Obstruction Released 1 Sewer Connection Permit Contractor: INLAND EMPIRE EXCAVATION Address: 10211 E DRIFTWOOD SPOKANE, WA 99206 Firm: INLAND EMPIRE EXCAVATION I Phone: (509) 891-1586 Item Description Units Unit Desc SEWER CONNECTION 1 NUMBER OF PROCESSING FEE 1 Y OR BLANK Operator: JAS Printed By: JAS Fee Amount $85.00 $15.00 Permit Total Fees: $100.00 Print Date: 5/28/02 Project Number: 02004122 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for' -tom nencing work without a permit Date: 5/28/02 Page 2 of 2 Notes:,rFF Payment Summary ,:;sflowr Permit Type Sewer Connection Permit Fee Amount $100.00 Invoice Amount $100.00 Amount Paid $0.00 Amount Owing $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: JAS Printed By: JAS Print Date: 5/28/02