2002, 03-21 Permit App: 02001823 Sewer Project Number: 02001823 Inv: 1 Application Date: 3/21/02 Page 1 of 2
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THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: SEWER CONNECTION-GOOD SAM.EXT Contact: BARNES ENTERPRISE
Address: PO BOX 141617
C-S-Z: SPOKANE WA 99214
Setbacks:Front Left: Right: Rear: Phone: (509)921-9068
Group Name:
Site Information:
Project Name:
Plat Key: 999999 Name: RANGE District: F
Parcel Number: 45241.9029 Block: Lot:
SiteAddress: 17010 E 4TH AVE Owner: Name: ROUNSVILLE,DALE L
VERADALE,WA USA 99037 Address: 17010 E 4TH AVE
Location::VER VERADALE WA 99037
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold: El
Area: 0 Sq Ft Width: 99 Depth: 440 Right Of Way(ft): 50
Nbr of Bldgs: 3 Nbr of Dwellings: 1
Review Information:
Review
Road Obstruction LReleased By: ♦
S M 0 J `-f C
Permits:
Sewer Connection Permit
Contractor: BARNES ENTERPRISES INC Firm: BARNES ENTERPRISES INC
Address: PO BOX 141617 Phone: (509)921-9068
SPOKANE WA 99214
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: JAS Printed By: JAS Print Date: 3/21/02
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Project Number: 02001823 Inv: 1 Apphi;ati o
Date: 3/21/02 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:
Printed B JAS Print Date: 3/21/02
Operator: JAS y�