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2002, 04-08 Permit App: 02002329 Plumbing Reversal, SewerProject Number: 02002329 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 4/8/02 Page 1 of 2 Project Information: Permit Use: PLBG REVERSAL/SEWER CONNECT/ARGONNE Contact: COURCHAINE EXCAVATION Address: 19818 E SPRAGUE C - S - Z: GREEENACRES, WA 99016 Setbacks: Front Left: Right: Rear: Phone: (509) 924-5485 Group Name: Project Name: Site Information: Plat Key: 002357 Name: SHANNON ACRES SUB Parcel Number: 45083.0139 Block: Lot: SiteAddress: 2015 N WOODRUFF RD SPOKANE, WA 99206 Location:: SPO Zoning: UNKN Unknown Water District: District: I i Owner: Name: MOYLE, FLORENCE Address: 2015 N WOODRUFF RD SPOKANE, WA 99206 Hold: ❑ Area: 0 Sq Ft Width: 60 Depth: 153 Right Of Way (ft): 40 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Review Road Obstruction Oa\s I p \°I3 Permits: Released By: (if -04'n l g 1 O Plumbing Permit Contractor: COURCHAINE CONSTRUCTION Firm: COURCHAINE CONSTRUCTION Address: 19818 E SPRAGUE AVE Phone: (509) 928-0846 GREENACRES, WA 99016 Item Description Units Unit Desc Fee Amount WATER PIPING - DWV 1 NUMBER OF 56.00 PROCESSING FEE 1 Y OR BLANK $25.00 MINIMUM FEE ADJUSTMENT 1 Select $4.00 Operator: JAS Printed By: JAS Permit Total Fees: $35.00 Print Date: 4/8/02 Project Number: 02002329 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 4/8/02 Page 2 of 2 Sewer Connection Permit Contractor: COURCHAINE CONSTRUCTION Firm: COURCHAINE CONSTRUCTION Address: 19818 E SPRAGUE AVE Phone: (509) 928-0846 GREENACRES, WA 99016 Item Description SEWER CONNECTION PROCESSING FEE Notes: Payment Summary:m: Permit Type Plumbing Permit Sewer Connection Permit Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Fee Amount $35.00 $100.00 Permit Total Fees: Invoice Amount $35.00 $100.00 $135.00 $135.00 Fee Amount $85.00 $15.00 $100.00 Amount Paid $0.00 $0.00 $0.00 Amount Owing $35.00 $100.00 $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: JAS Printed By: JAS Print Date: 4/8/02