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2004, 09-02 Permit: BLD-07551 Cross ConnectSpokane .0,00Valley 11707 E. Sprague Ave., Suite 106 Spokane Valley, WA 99206 Job Address: 14903 E 24TH AVE SPOKANE VALLEY WA 99037 Description: 1 -DOUBLE CHECK VALVE Subdivision: Owner: Applicant: Address: Contractor: Address: SCHOLTENS, TOM & LAURA PLUMBING PERMIT Lot: Blk: Parcel No: HAASE LANDSCAPE INC Phone: (509) 926-7950 12202 E THORPE RD SPOKANE, WA 99212 HAASE LANDSCAPE INC 12202 E THORPE RD SPOKANE WA 99212 Phone: Lic No: (509) 926-7950 HAASELI042R6 Permit #: Applied: Issued: Expires: BLD -04-07551 Zoning: 09/02/2004 09/02/2004 03/01/2005 General Information: SUPPLEMENTAL PERMIT CROSS CONNECTION DEVICE N 1 Fees: PLUMBING PROCESSING FEE CROSS CONNECTION DEVICE Total Calculated: Deposits/Receipts: Total Due: 35.00 6.00 41.00 41.00 0.00 Disclaimer: The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the property owner. 3) The signatory is the property owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. Ownership of resulting development rights granted by any issued permit inure to the property owner. Print Name Staff Initials Signature THIS IS NOT A RECEIPT 9//D y Date