1995, 09-26 Permit App: 95007695 Sewer PROJECT NUMBER= 95007695 APPLICATION DATE= 09/26/95 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 13920 E 16TH AVE PARCEL#= 45262 .0901
ADDRESS= VERADALE WA 99037
PERMIT USE= SEWER CONNECTION - EARLY DAWN (95S-883)
PLAT#= 001451 PLAT NAME= LEMEN AIRPARK ADD
BLOCK= 8 LOT= 1 ZONE= AGRI DIST#= F
AREA= 00000000 F/A= F WIDTH= 100 DEPTH= 125 R/W=
# OF BLDGS= # DWELLINGS= 1 WATER DIST =
OWNER= AMES, CHARLES PHONE= 509 924 6840
STREET= 13920 E 16TH AVE
ADDRESS= VERADALE WA 99037
CONTACT NAME= ARMSTRONG CONSTRUCTION PHONE NUMBER= 509 928 0559
BUILDING SETBACKS: FRONT= N/A LEFT= N/A RIGHT= N/A REAR= N/A
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
UTILITIES CONNECTION APPROVAL REQUIRED OK_ To tSSu.* MC-,tito
COMMENTS: Pepm. 1:44-'re
***************************** SEWER PERMIT ******************************
CONTRACTOR= ARMSTRONG CONSTRUCTION PHONE= 509 928 0559
STREET= P 0 BOX 14282
ADDRESS= SPOKANE WA 99214
ITEM DESCRIPTION QUANTITY FEE AMOUNT
PROCESSING FEE Y 10. 00
SEWER CONNECTION 1 40.00
******************************* PAYMENT SUMMARY ****************************
PAYMENT DATE RECEIPT# PAYMENT AMOUNT
09/26/95 00009096 50.00
TOTAL DUE= . 00 TOTAL PAID= 50. 00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
PROJECT NUMBER= 95007695 APPLICATION DATE= 09/26/95 PAGE= 02
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
SEWER PERMIT 50. 00 50. 00 . 00
50. 00 50. 00 . 00
PROCESSED BY: BURRIS, ROBIN
PRINTED BY: WENDEL, GLORIA
******************************** THANK YOU ************************************
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 from the date of issuance. No
extensions will be granted.
PROJECT INFORMATION
Job address: ` Dry Line Owner's na
Ag,r.2 / Sewer? (Y/N)•
City: City/State:
•
Zip: Zip:
Parcel number(if known): Phone:
9.,>2 Vc2
First-time contractors or home-owners performing the installation must first contact the utilities department(in person
or via phone[456-3604]) before a permit can be issued.
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Contractor(company name): State contractor license number:
AlK\5+C roticiisr isigm 2. N 1
Business address: J Utilities installers permit number:
Po N 142.,E.2.
City/State: cn kl1,t', vJA
Zip: Ct cl Zl Phone: Q Zg • o5S cf
INTERIOR PLUMBING ALTERATIONS? (yes/no) circle one
Fill out the information in the table below if applicable**
Contractor(if different from above): Phone: at 2`) - cio cp,'R
r c :),14- Aow150()
Business Address: City/State/Zip:
1152 (7411 <1rp-emsrrWA c1ctottc,
mYi!''.il�!"il,l..jii.ilii! i;.i;I
N:njjl,101;.,y', : .I�r,l-
, al� Nbl��1,
FEE INFORMATION
Sewer Connection: Number of Buildings X(times)$50(per bldg) _ $
TOTAL FEE
*One permit required for each'separate building,shop,garage, etc.,that will be connected to the sewer.
*Condos,townhouses, &2-3-and 4-plexes require 1 permit per address/stub.
*Multiple buildings(apartments, industrial complexes)require 1 permit per building.
(For situations not cover d here, call the County Utilities Division @ 456-3604) /�
APPLICANT SIGNATURE: (_ 1 �� Date: /e/V--e;Ar
erolOwYba
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260
PHONE: (509)456-3675 * FAX: (509) 324-3198 * TDD: (509) 324-3166
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in,its programs or activities.
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