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2002, 02-19 Permit App: 02000953 Sewer Project Number: 02000953 Inv: 1 ' Application Date: 2/19/02 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-EASTERN Contact: COURCHAINE CONSTRUCTION Address: 19818 E SPRAGUE C- S-Z: GREENACRES,WA 99216 Setbacks: Front Left: Right: Rear: Phone: (509)924-5485 Group Name: Site In formation: Project Name: Plat Key: 000735 Name: EMPIRE HEIGHTS ADD District: E Parcel Number: 35241.2815 Block: Lot: SiteAddress: 7003 E 6TH AVE Owner: Name: WALKOWIAK,MARK SPOKANE,WA 99212 Address: 7003 E 6TH AVE Location::SPO SPOKANE,WA 99212 Zoning: MFS Water District: Hold: ❑ Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 60 Nbr of Bldgs: 0 Nbr of Dwellings: 1 Review Information: Review Road Obstruction Released By: `.__ Sl ) 7-1 Permits: Sewer Connection 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 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: 2/19/02 Project Number: 02000953 Inv: 1 Application k Date: 2/19/02 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: 2/19/02