2004, 12-30 Permit App: 04009390 Sewer Project Number: 04009390 Inv: 1 Application Date: 12/30/2004 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-TURTLE CREEK SOUTH Contact: HOMESTEAD CONSTRUCTION INC
2ND Address: 312 S FARR RD
C- S-Z: SPOKANE,WA 99206-3666
Setbacks: Front Left: Right: Rear: Phone: (509) 892-0454
Group Name:
Site Information: Project Name:
Plat Key: Name: TURTLE CREEK SOUTH 02ND ADD District: G
Parcel Number: 55194.1909 Block: 3 Lot: 9
SiteAddress: 18104 E 11TH AVE Owner:Name: HOMESTEAD CONSTRUCTION IN
Address: 312 S FARR RD
Location::GRE SPOKANE,WA 99206-3666
Zoning: UNKN Unknown
Water District: Hold: ❑
Area: .00 Acres Width: 0 Depth: 0 Right Of Way(ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Review
1 z./36•704
Q
Review by Utilities Released B ;± 1�t.uvGV�
HA, VC. 6 F C V s u 0.640 l-.
Permits:
Sewer Connection Permit
Contractor: FOLSOM EXCAVATING INC Firm: FOLSOM EXCAVATING
Address: 16701 E VALLEYWAY AVE Phone: (509)891-1232
VERADALE,WA 99037
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: JAS Printed By: JAS Print Date: 12/30/2004
Project Number: 04009390 Inv: 1 Application Date: 12/30/2004 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes:
See plat file for TURTLE CREEK SOUTH 2ND for special drainage requirements
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 construed 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: 12/30/2004
. . ... ... . . . Spokane Cotin'ty.Division'orUtilities _. ..._.
SEWER CONNECTION PERMIT APPLICATION FORM
PLEASE NOTE: This application form must be filled out accurately and in its entirety,and signed,or a permit will not be issued. Also note
that sewer permits are valid for 12 months form the date of issuance. No extensions will be granted. A separate right-of-way permit is
required for any work performed in or from the county right-of-way.
PROJECT INFORMATION
•
Job Address: \ . \\\Q c \
•Owner's name: •��, - C �•,,�,
\\
Project Name: w Address:
ULID Name: ` """).-=.c).
City/State: ��.r s` 1k4•
CHECK APPLICABLE BOXES.
Si Regular 6 Residential New Zip: Ns\>-`Z
O Dry Sewer O Commercial 0 New Phone.
❑ Repair 0 Temporary
o Addition •
• •
* FIRST TIME CONTRACTORS OR HOME OWNERS PERFORMING THE INSTALLATION MUST FIRST CONTACT TI
UTILITIES DIVISION BEFORE PERMIT(S)CAN BE ISSUED.
* SIGNATURE OF UTILITIES DIVISION PERSON CONTAC 11;U:
Contractor(company name): Sate contractor license number:
•
•
Business address: Contact Name:
City/State: Zip:_
• Phone Number:
INTERIOR PLUMBING ALTERATIONS? (yes/kg circle one
Fill out the information in the table below ifapplicable••
•
Contractor(if different from above): Phone:
l.X s
Business Address: City/State/Zip :,t
ti; � •., ''•' y a•J� .+ yy� yam• r.. �. . . �' �[ ,
_.....r...r�.. •+i�vt: i•' :t $41, �fi; .41: 1PF:� liiiia4;";!(O'�'boli t3.. i�ir:fi'CeOriii�ir>7ifZti�lrr I�.... +�.
FEE INFORMATION
Number of Buildings connecting to sewer X(times)$100(per bldg) - $
TOTAL Yfl
• Fora single-family residential unit,one permit is red;
• For a condominium,townhouse,duplex,triplex or lourplac with separate ownership(as determined by lot lines)separate address and separate stub.oat permit is required per
address per stub;
• For a single building duplex,triplex or fourpla with single ownership,one permit is required
• Multiple buildings(apartment;industrial complexes)with single ownership,one permit required per building connecting to the sewer.
(FOR SITUATIONS NOT COVERED HERE,CALL THE COUNTY DMSION OF UTILITIES AT 477-3404) -
'Is any of the work to be performed in or from the county right-of-way? 0 Yes, l9 No
APPLICANT SIGNATURE: DATE: \Z. `�."\ fk"
Method of Payment: .. •
O Cash G Check G Visa 0 MasterCard Cl Discover Card
Date: Expires:
•
. Bankcard Number: "
Authorized Signature:
Spokane County Division of Building 84 Code Enforcement
1026 West Broadway Avenue*Spokane'WA 99260
I-,•I N,, (cnn) 477 1r-yr . r,. rensv 477 71n1? "T7'Yfl'. , 15nOv 477.711A