2001, 12-06 Permit App: 01010679 SewerProject Number: 01010679 Inv: I Application Date: 12/6/2001 Page I of 2
. I THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Proiect Information:
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Permit Use: SEWER CONNECTION - SULLIVAN PARK Contact: COURCHAINE CONSTRUCTION
ASSISTED LIVING Address: 19818 E SPRAGUE
C - S - Z: GREENACRES, WA 99216
Setbacks: Front Left: Right: Rear: Phone: (509) 924-5485
Group Name:
Site Information: Project Name:
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Plat Key: 002751 Name: VERA District: F
Parcel Number: 45231.0644 Block: Lot:
SiteAddress: 14715 E 4TH AVE Owner: Name: HENDRICKSON,
SPOKANE, WA 99206 Address: 14717 E 4TH AVE
Location:: SPO SPOKANE, WA 99206
Zoning: UNK
Water District: Hold: F-1
Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 40
Nbr of Bldgs: 0 Nbr of Dwellings: 1
Review Information: . .........................................
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Review
Road Obstruction
Releasedf},..
10/ -VI-D 61;h
Item Description
SEWER CONNECTION
PROCESSING FEE
Units Unit Desc Fee Amount
1 NUMBER OF $85.00
1 Y OR BLANK $15.00
Permit Total Fees: $100.00
Operator: RNIB Printed BY: RNIB Print Date: 12/6/2001
Project Number: 01010679 Inv: 1 Application Date: 12/6/2001 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes: ::
P e tSummary:
a m n
Permit Tyne 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.
Operator: RMB Printed By: RMB Print Date: 12/6/2001