16-089.00 Spokane County Utilities: City Hall Sewer Connection )6-0S1
UTILITIES DIVISION
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A DIVISION OF THE PUBLIC WORKS DEPARTMENT
Kevin R.Cooke,P.E.,Utilities Director
SPOKAK Cot/NM'
SEWER CONNECTION CHARGE AGREEMENT
PLEASE NOTE:Agreement must be Mad out accurately and in Its entirety,and signed,prior Ni pemdf issuana-
Date: 5/12/16 Plat Name: N/A Lot It - Block#: -
Site Address: 10210 E.Sprague Ave. Parcel#: 45201.0122
Owner's/Builder's Name: City of Spokane Valley Sewer Project: E.Sprague Basin A
Please PRINT Owner's/Builder's Name
[1 Single Earn ❑Duplex ❑ Multi-Earn ❑ADU/MHP LIComm'l New ERU's Assigned: 3.31
Applicable ❑ Construction Cost Component(CCC)of CFR 0.0 @ $3,560.00 = $0.00
Charges: E Unsubsidized General Facilities Charge(GFC) 3.3 @ $4,630.00 = $15,325.30
Li Subsidized General Facilities Charge(GFC) 0.0 @ $2,780.00 = $0.00
❑ Special Connection Charge(SCC) 0.0 @ $3,560.00 = $0.00
❑ Developer Credit: SCC/CCC- $0.00 GFC-$0.00 Sub-Total = $15,325.30
Payment Option Selected (Check One): TOTAL: = $15,325.30
j 1. All Charges Paid at Issuance of Sewer Connection Permit.
Payment Received By: lv1G'I` Amount Paid: I S 3x5.3 0 Receipt k: - Check#: 3(6Li"f'J
❑ 2. All Charges to be paid in full at closing of sale of the property. (Sale prior to occupancy ONLY.)
Total=
❑ 3. Bill in one lump sum the next billing cycle on (Late charges may apply if not paid timely,
❑ 4. Finance All or Portion of Charges: (6%annual interest applies)
Billing Start: ❑ Next Monthly Billing Cycle ❑ Upon Occupancy
Payment Received By: Amount Paid: Receipt U: Check U:
SCC/CCC+GFC—select up to 240 months, GFC ONLY—select up to 120 months
#Months. Exsisting Charges for Pre-Paid Charges to be Monthly
0 0 ERU Balance ERU Increase Amount Financed, Rates
0 GFC — — — — ---------
tp Z
,17 SCC/CCC -------- — ------- ---
1 Bond -- --- -- ------
►�°_ Interest ----- ____
TOTAL -- ---
Acknowledgement:I understand that the charges outlined above ore based on the indicated use of the property. Future changes
in use of the property or increased water usage on commercial properties may result in the requirement to pay additional Sewer
Connection Charges. I also understand that sewer connection permits are valid for one year from the date of issuance. if the sewer
connection is not fully completed and inspected within the one-year life of the permit,a new permit will be required and new rates
may apply.I agree to the terms presented above,recognizing that I may pay the remaining principal balance in full at any time
without penalty.I understand that partial payments of$500 or more will result in a reduction in monthly rates,and that
refinancing is only available in the event that additional connection charges become due.
Signature of Owner/Builder: / r
g ;V(>�, � Q��pf�,,_)1 ,,1A Ll'y air Date: SIRD7 lc
Signature of Utilities Staff Prepared By: 711C-D-iirDate: 5/2.4/(6,
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Signature of Utilities Staff Reviewed By: ' Date: . —aZ /-/i:
1026 West Broadway Avenue,4th Floor - Spokane,WA 99260-0430
PHONE: (509)477-3604 - FAX: (509)477-4715 ` TDD: (509)477-7133
Spokane County,Division of Utilities Charge Agreement,Revised 3/29/16