2001, 12-14 Permit App: 01010832 Sewer Project Number: 01010832 Inv: 1 Application Date: 12/14/01 Page 1 of 2
.01
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: SEWER CONNECTION-MIDILOME EAST 2ND Contact: CLIFF SCHMITZ CONSTRUCTION
Address: 16520 E SECRETARIAT
C-S-Z: VERADALE WA 99037
Setbacks: Front Left: Right: Rear: Phone: (509)922-4297
Group Name:
Site Information: Project Name:
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Plat Key: 006071 Name: MIDILOME EAST 2ND District: F
Parcel Number: 45342.1204 Block: 4 Lot: 4
SiteAddress: 12814 E 36TH AVE Owner:Name: CLIFF SCHMITZ CONSTRUCTION
SPOKANE,WA USA 99216 Address: 16520 E SECRETARIAT
Location::SPO VERADALE WA 99037
Zoning: UNKN Unknown
Water District: 007 MODEL Hold: ❑
Area: 1,000 Sq Ft Width: 80 Depth: 125 Right Of Way(ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information: :mm gig.. . �- W4 ....
Review
Review by Utilities
Released Bf:" t � t` >1 i2j/
Sewer Connection Permit
Contractor: FOLSOM EXCAVATING INC Firm: FOLSOM EXCAVATING
Address: 16701 E VALLEYWAY AVE Phone: (509)891-1232
VERADALE,WA 99037
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: JAS Printed By: JAS Print Date: 12/14/01
Project Number: 01010832 Inv: 1 Applicatian Date: 12/14/01 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes:
Payment Summary: �k_ r�
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 contrued 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: JAS Printed By: JAS Print Date: 12/14/01