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2002, 04-22 Permit App: 02002780 Sewer Project Number: 02002780 Inv: I Application Date: 4/22/2002 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SEWER CONNECTION-LONGVIEW PUD Contact: HAYDEN ENTERPRISES Address: 3327 W INDIAN TRAIL RD#232 C-S -Z: SPOKANE,WA 99208 Setbacks: Front Left: Right: Rear: Phone: (509)994-4691 Group Name: Site Information: Project Name: Plat Key: 006175 Name: LONGVIEW District: G Parcel Number: 55192.0359 Block: 1 Lot: 9 SiteAddress: 17634 E 4TH LN Owner: Name: HAYDEN ENTERPRISES SPOKANE,WA USA 00000 Address: 3327 W INDIAN TRAIL RD#232 Location:: SPO SPOKANE,WA 99208 Zoning: UR-3.5 Urban Residential 3.5 Water District: Hold: ❑ Area: 6,387 Sq Ft Width: 50 Depth: 126 Right Of Way(ft): 38 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Review Review by Utilities Released By: 1 , Permits: Sewer Connection Permit Contractor: HAYDEN ENTERPRISES INC Firm: HAYDEN ENTERPRISES INC Address: 17626 E 2ND Phone: (509)994-4691 GREENACRES WA 99016 Item Description Units Unit Desc Fee Amount SEWER CONNECTION 1 NUMBER OF $85.00 PROCESSING FEE I Y OR BLANK $15.00 Permit Total Fees: $100.00 Operator: RMB Printed By: RMB Print Date: 4/22/2002 Project Number: 02002780 Inv: 1 Application Date: 4/22/2002 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: RMB Printed By: RMB Print Date: 4/22/2002