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2002, 01-18 Permit App: 02000324 Sewer Project Number: 02000324 Inv: 1 Application Date: 1/18/02 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: DRYLINE SEWER CONNECTION/SP-1267-01 Contact: ROGER GIDDINGS EXCAVATION Address: 11812 E.BIGELOW GULCH C-S-Z: SPOKANE,WA.99217 Setbacks:Front Left: Right: Rear: Phone: (509)922-5907 Group Name: Site Information: Project Name: Plat Key: 001179 Name: HELSTROM REPLAT MISSION-PINES District: F Parcel Number: 45161.0213 Block: Lot: SiteAddress: 1304 N WILBUR RD Owner:Name: NIEHENKE,ELMER SPOKANE,WA 99206 Address: 1304 N WILBUR RD Location::SPO SPOKANE,WA 99206 Zoning: UR-3.5 Urban Residential 3.5 Water District: Hold: ❑ Area: 0 Sq Ft Width: 90 Depth: 120 Right Of Way(ft): 50 Nbr of Bldgs: 2 Nbr of Dwellings: 1 Review CAL, ‘,C2 P�1- Review by Utilities Released c Lf t` Sewer Connection Permit Contractor: ROGER GIDDING Firm: ROGER GIDDINGS EXCAVATION Address: 11812 E BIGELOW GULCH RD Phone: (509)922-5907 SPOKANE,WA 99207 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: CKF Printed By: CKF Print Date: 1/18/02 Project Number: 02000324 Inv: 1 Application Date: 1/18/02 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Notes: Payment Summary: Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Sewer Connection Permit $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: CKF Printed By: CKF Print Date: 1/18/02