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2001, 11-29 Permit App: 01010508 Sewer, Plumbing Reversal Project Number: 01010508 Inv: 1 Application Date: 11/29/01 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: PLUMBING REVERSAL/SEWER Contact: ALLIED SEWER&BORING CONNECT/APPLE VALLEY Address: 9317 S FREEMAN DR C-S-Z: MEDICAL LAKE,WA 99022 Setbacks:Front Left: Right: Rear: Phone: (509)924-8508 Group Name: Site Information: Project Name: Plat Key: 999999 Name: RANGE District: F Parcel Number: 45213.9147 Block: Lot: SiteAddress: 11407 E 9TH AVE Owner:Name: GOTTSCHALK„J SPOKANE,WA 99206 Address: 11407 E 9TH AVE Location::SPO SPOKANE,WA 99206 Zoning: UNKN Unknown Water District: Hold: ❑ Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 60 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: _ :.: . :_ F � .. _016'M Review Road Obstruction ` ., I Released By: 44 D-! 5 GNB'17 Permits: iDsr"��F"'... _.,." "::._"" :-:s:?Y,a °i10,,:,, Plumbing Permit Contractor: BESTWAY PLUMBING Firm: BESTWAY PLUMBING Address: 18416 E ALKI AVE Phone: (509)922-1541 GREENACRES,WA 99016 Item Description Units Unit Desc Fee Amount WATER PIPING-DWV 1 NUMBER OF $6.00 PROCESSING FEE 1 Y OR BLANK $25.00 MINIMUM FEE ADJUSTMENT 1 Select $4.00 Permit Total Fees: $35.00 Operator: JAS Printed By: JAS Print Date: 11/29/01 Project Number: 01010508 Inv: 1 Application Date: 11/29/01 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Sewer Connection Permit Contractor: ALLIED SEWER BORING Firm: ALLIED SEWER BORING COMPA Address: 9317 S FREEMAN DR Phone: (509)924-8508 MEDICAL LAKE,WA 99022 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 Notes: Payment Summary: Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Plumbing Pecnut $35.00 $35.00 $0.00 $35.00 Sewer Connection Permit $100.00 $100.00 $0.00 $100.00 $135.00 $135.00 $0.00 $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: 11/29/01