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2002, 01-07 Permit App: 02000088 Sewer, Plumbing ReversalProject Number: 02000088 Inv: 1 Application THIS IS NOT A PERMIT Date: 1/7/2002 Page 1 of 2 Penalties will be assessed for commencing work without a permit Proiect Information: Permit Use: SEWER CONNECTION - EASTON 2 & Contact: H & S CONSTRUCTION PLUMBING REVERSAL Address: 11817 E. VALLEYWAY AVE C - S - Z: SPOKANE WA 99206 Setbacks: Front Left: Right: Rear: Phone: (509) 926-8964 Group Name: Project Name: Site Information: Plat Key: 001834 Name: OPP.TR. 1-354 District: F Parcel Number: 45163.0304 Block: 129 SiteAddress: 11404 E VALLEY WAY SPOKANE, WA USA 00000 Location:: SPO Zoning: UR -3.5 Water District: Urban Residential 3.5 Area: 17,500 Sq Ft Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Lot: 0 Owner: Name: Address: BLOUNT, W A 11404 E VALLEYWAY AVE SPOKANE, WA 99206-7226 Hold: Depth: 0 Right Of Way (ft): 0 Review Road Obstruction Permits: Contractor: JACKSON PLUMBING Address: P.O. BOX 7272 SPOKANE, WA 99207 Item Description WATER PIPING - DWV PROCESSING FEE MINIMUM FEE ADJUSTMENT Plumbing Permit Firm: RANDY JACKSON PLUMBING Phone: (509) 926-7101 Units Unit Desc 1 NUMBER OF 1 Y OR BLANK 1 Select Operator: RMB Printed By: RMB Permit Total Fees: Print Date: Fee Amount $6.00 $25.00 $4.00 $35.00 1/7/2002 Project Number: 02000088 Inv: 1 Application Date: 1/7/2002 Page 2 of 2 • THIS IS NOTA PERMIT Penalties will be assessed for commencing work without a permit Sewer Connection Permit Contractor: H & S CONSTRUCTION Firm: H & S CONSTRUCTION Address: 11817 E VALLEYWAY AVE SPOKANE, WA 99206 Item Description SEWER CONNECTION PROCESSING FEE Notes: ;.. Permit Type Plumbing Permit $35.00 $35.00 Sewer Connection Permit $100.00 $100.00 $0.00 $100.00 Phone: (509) 926-8964 Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Fee Amount $85.00 $15.00 Permit Total Fees: $100.00 Fee Amount Invoice Amount Amount Paid Amount Owing $0.00 $35.00 $135.00 $135.00 $0.00 $135.00 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: RMB Printed By: RMB Print Date: 1/7/2002