2002, 06-21 Permit App: 02005074 Sewer Project Number: 02005074 Inv: 1 P-rpphcation Date: 6/21/2002 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 Contact: CHD,INC.
Address: PO BOX 13717
C -S-Z: SPOKANE,WA 99213
Setbacks: Front Left: Right: Rear: Phone: (509) 926-5229
Group Name:
Site Information: Project Name:
Plat Key: 999999 Name: RANGE District: D
Parcel Number: 35234.9106 Block: Lot:
SiteAddress: 5508 E 8TH AVE Owner: Name: KACHINSKY,D J
SPOKANE,WA USA 00000 Address: 716 S KOREN RD
Location:: SPO SPOKANE,WA 99212-0385
Zoning: UR-7 Urban Residential-7
Water District: Hold: ❑
Area: 4.07 Acres Width: 0 Depth: 0 Right Of Way(ft): 60
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information: :.
Review
Review by Utilities Released By:
Permits: .
Sewer Connection Permit
Contractor: WES CROSBY Firm: C H D INC
Address: P 0 BOX 13717 Phone: (509)926-5229
SPOKANE,WA 99213
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: DMD Printed By: DMD Print Date: 6/21/2002
l
Project Number: 02005074 Inv: 1 Application Date: 6/21/2002 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: DMD Printed By: DMD Print Date: 6/21/2002