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2001, 09-27 Permit App: 01008436 Sewer Project Number: 01008436 Inv: 1 Application Date: 9/27/2001 Page 1 of 1 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SEWER CONNECTION-WELLESLEY MANOR Contact: VIETZKE EXCAVATING Address: 2011 S CRAIG RD C-S -Z: MEDICAL LAKE,WA. 99022 Setbacks: Front Left: Right: Rear: Phone: (509)535-4814 Group Name: Site Information: Project Name: Plat Key: 002851 Name: WELLESLEY MANOR 4TH ADD District: Parcel Number: 46363.0311 Block: Lot: SiteAddress: 15922 E WABASH AVE Owner:Name: SIMPSON,DAN SPOKANE,WA 99216 Address: 15922 E WABASH AVE Location::SPO SPOKANE,WA 99216 Zoning: SFR Water District: Hold: [1] Area: 0 Sq Ft Width: 96 Depth: 128 Right Of Way(ft): 0 Nbr of Bldgs: 2 Nbr of Dwellings: 1 Department Review ENGINEER Road Obstruction Released By °I 9 X-7-42' Hold Reasons: Permit Conditions: c/ S ir3J4515 Sewer Connection Permit Contractor: VIETZKE EXCAVATING Firm: VIETZKE EXCAVATING Address: 2011 S CRAIG RD#1 Phone: (509)244-9607 MEDICAL LAKE,WA 99022 Item Description Units Unit Desc Fee Amount SEWER CONNECTION 1 NUMBER OF $85.00 PROCESSING FEE 1 Y OR BLANK $15.00 Permit Total Fees: $100.00 Operator: RMB Printed By: RMB Print Date: 9/27/2001 Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Sewer Connection Penult $100.00 $100.00 $0.00 $100.00 $100.00 $100.00 $0.00 $100.00