2003, 03-03 Permit App: 03001236 Sewer Project Number: 03001236 Inv: 1 Application Date: 3/3/2003 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 -DISHMAN COMMONS Contact: GREENSTONE CONSTRUCTION,INC.
Address: 707 W 7TH AVE STE 320
C-S -Z: SPOKANE,WA 99204-2833
Setbacks: Front Left: Right: Rear: Phone: (509)458-5860
Group Name:
Site Information: Project Name:
Plat Key: Name: District: F
Parcel Number: 45291.2118 Block: 2 Lot: 11A
SiteAddress: 10201 E 17TH LN Owner: Name: GREENSTONE CONSTRUCTION,
SPOKANE,WA USA 00000 Address: 707 W 7TH AVE STE 320
Location::SPO SPOKANE,WA 99204-2833
Zoning: UR-12 Urban Residential-12
Water District: Hold: ❑
Area: 4,539 Sq Ft Width: 42 Depth: 106 Right Of Way(ft): 32
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Review by Utilities
Released ' Z�a
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Permits: ..
Sewer Connection Permit
Contractor: OWNER Firm: OWNER
Phone:
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: CKF Printed By: CKF Print Date: 3/3/2003
Project Number: 03001236 Inv: 1 Application Date: 3/3/2003 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes .
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: CKF Printed By: CKF Print Date: 3/3/2003
Spokane County Division of Utilities
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 issuan'te: 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: /O 2 C) ( -. (7 � rl e
/ &rte.+) Owner's name: Greens tone Construction
L
Parcel Number: ?"1/,`11 Z C) Lot: i(/g' Block: Z
Project Name: i h C'rs r..4 c,n s Address: 1421 N. Meadowwood Lane
ULID Name:
City/State: Liberty Lake, WA.
CHECK APPLICABLE BOXES
❑ Regular ECK Residential X®KNew Zip: 99019
❑ Dry Sewer O Commercial 0 New
0 Repair 0 Temporary Phone: (509) 458-5860
❑ Addition
❑ Abandonment
Is any of the work to be performed in or from the county right-of-way? 0 Yes* in No
FIRST TIME CONTRACTORS OR HOME OWNERS PERFORMING THE INSTALLATION MUST FIRST CONTACT THE
UTILITIES DIVISION BEFORE PERMIT(S)CAN BE ISSUED.
SIGNATURE OF UTILITIES DIVISION PERSON CONTACTED:
Contractor(company name): Sate contractor license number:
Same As Owner GREENCL044RQ
Business address: Contact Name:
City/State: Zip: Mik Bondurant
Phone Number: (509) 252-7507 ext. 105
INTERIOR PLUMBING ALTERATIONS? (ye.f no de one
Fill out the information in the table below if applicable**
Contractor(if different from above): Phone:
Business Address: City/State/Zip
FEE INFORMATION
Number of Buildings connecting to sewer X(times)$100(per bldg)_ $ + $10.00=
RIGHT OF WAY PERMIT
• For a single-family residential unit,one permit is required;
• For a condominium,townhouse,duplex,triplex or fourplex with separate ownership(as determined by lot lines)separate address and separate stub,one permit is required per
address per stub;
• For a single building duplex,triplex or fourplex with single ownership,one permit is required
• Multiple buildings(apartments,industrial complexes)with single ownership,one permit required per building connecting to the sewer_
(FOR SITUATIONS NOT COVERED HERE,CA THE COUNTY DIVISION OF UTILITIES AT 477-3604)
APPLICANT SIGNATURE: /� „ic/� DATE: 2-74
Method of Payment:
❑ Cash 0 Check 0 Visa 0 MasterCard 0 Discover Card
Date: Expires:
Bankcard Number:
Authorized Signature:
Spokane County Division of Building&Code Enforcement
1026 West Broadway Avenue*Spokane WA 99260
Tel.No_(509)477-3675*Fax No.(509)477-7198*TDD No.(509)477-7133