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2002, 07-30 Permit App: 02006441 SewerProject Number: 02006441 Inv: 1 Application Date: 7/30/02 Page 1 of 2 THIS IS NOT A 1ERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SEWER CONNECTION - EASTON 2 Contact: H & S CONSTRUCTION Address: 11817 E. VALLEYWAY AVE C - S - Z: SPOKANE WA 99206 Setbacks: Front Left: Right: Rear: Phone: (509) 926-8964 Group Name: Site Information: Project Name: Plat Key: 001852 Name: OPPORTUNITY(TR.1-142INC.143-354) District: F Parcel Number: 45163.0453 Block: Lot: SiteAddress: 10824 E VALLEYWAY AVE SPOKANE, WA 99206 Location:: SPO Zoning: UNKN Unknown Water District: Owner: Name: VAN WAGONER, ALLEN Address: 10824 E VALLEYWAY AVE SPOKANE, WA 99206 Hold: ❑ Area: 0 Sq Ft Width: 66 Depth: 146 Right Of Way (ft): 40 Nbr of Bldgs: 0 Nbr of Dwellings: 1 Review Information: Review Road Obstruction Permits: Released By: Sewer Connection Permit Sof ri -3a •dam Contractor: H & S CONSTRUCTION Firm: H & S CONSTRUCTION Address: 11817 E VALLEYWAY AVE SPOKANE, WA 99206 Phone: (509) 926-8964 Item Description Units Unit Desc Fee Amount SEWER CONNECTION 1 NUMBER OF $85.00 PROCESSING FEE 1 Y OR BLANK $15.00 Operator: JAS Printed By: JAS Permit Total Fees: $100.00 Print Date: 7/30/02 Project Number: 02006441 Inv: 1 Application Date: 7/30/02 Page 2 of 2 THIS ISNOT A PERMIT Penalties will be assessed for commencing work without a permit Notes: Payment Summary: Permit Tvpe Sewer Connection Permit Fee Amount Invoice Amount Amount Paid Amount Owing $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: JAS Printed By: JAS Print Date: 7/30/02