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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. UWEc\w voce .pik