2005, 07-09 SHP-09-04 GFC Payment recordifitr -7 f •
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PLEASENM FbM RMA be MbdarAatcctlnEe WOW Ill; wt*, andsbjK arepwl* %W jWj a Awled
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Plat Nams; �S)4 GD -04 . �-Ai L.ot Nasi = fleck Nasi:
site Addre gay. G • ( 5 2 ( s 4 -r,i ,cy �,)t e . Parcel "s).
Owner NWW LAa( WaLeZ .OR Binder Nmw
PIANT Ownses Nmne
_45Z31- 1516 _
( PA M ['L'
1. ❑ GFC pomment received at WKwM of Sewer Connection Pw mk by of tldtyties
2. ❑ GFC to be paid at closing. Sea Special COnditM below regarding GFC tate.
3��,&C payment in 24 equal newly payments upon establishment of Sewer BHli g Account.
Specht Conditions below, regardbrg QFC rate.
ff Opdon No. 3 is s corgMite ours of 9W *Wowbg senewnwdw
a. Owner's Stelanio t 1, understand that 1 will be
billed for this q*dcabts QFC amount in 24 monthly irnebt0r*L The monthly GFC inshOgmw is wM be added
to my monthly sewer service cups.
b. Butt W$ Ste WW* 1. underaWld that because 1
am selecting this option for payment of the GFC, the purchaser of the home will be responabb for payment of
Un applicable GFC in 24 alum monthly km taSnsntL i agres to formally dsdkme to potential buyers of the
property that the GFC charges will be added to the moW* sewer service bilibp ae soon as billing
Cemmencss.
Special CondU ons: Sewer connection permits ars valid for 12 months from data of issue, if final conned in
-riot completed and tnepected withln,ft 12 -month life of the permit, a new permit will be required'o W the GFC rats
tl'W is, in effect when this now pwmt is issued will apply.
Other Special Conditkm&- ❑ No ❑ Yes — See Reverse Side of Form
C7wnees or Builder's Signature
4
Located at: 1026 W. Broadway,
Spokane County, Div�stan of Ut6 W. Broadway • Spokane, WA
option Form, Revased 02-"