2002, 05-21 Permit App: 02003933 Sewer Project Number: 02003933 Inv: 1 Application Date: 5/21/02 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-PONDEROSA Contact: SHORT SEPTIC SERVICE INC
Address: 3350 WILLIAMS RD E
C-S-Z: ALMIRA WA 99103
Setbacks: Front Left: Right: Rear: Phone: (509)639-2393
Group Name:
Site Information: Project Name:
Plat Key: 003423 Name: FOREST MEADOW 2ND ADD District: F
Parcel Number: 45333.1506 Block: Lot:
SiteAddress: 11406 E 42ND CT Owner:Name: ANDREAS,RICK
SPOKANE,WA 99206 Address: 11406 E 42ND CT
Location::SPO SPOKANE WA 99216
Zoning: UNKN Unknown
Water District: Hold: ❑
Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 50
Nbr of Bldgs: 0 Nbr of Dwellings: 1
Review Information:
Review
Road Obstruction Released By:
(21 tr/r....-'1
1 S Loqolk-
Plumbing Permit
Contractor: OWNER Firm: OWNER
Phone:
Item Description Units Unit Desc Fee Amount
WATER PIPING-DWV 1 NUMBER OF $6.00
MINIMUM FEE ADJUSTMENT 1 Select $29.00
Permit Total Fees: $35.00
Operator: CKF Printed By: CKF Print Date: 5/21/02
Project Number: 02003933 Inv: 1 Application Date: 5/21/02 Page 2 of 2
THIS IS NOT A.PERMIT
Penalties will be assessed for commencing work without a permit
Sewer Connection Permit
Contractor: SHORT SEPTIC SERVICE INC Firm: SHORT SEPTIC SERVICE INC
Address: 3350 WILLIAMS RD E Phone: (509)639-2393
ALMIRA WA 99103
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
Notes:
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Plumbing Permit $35.00 $35.00 $0.00 $35.00
Sewer Connection Permit $100.00 $100.00 $0.00 $100.00
$135.00 $135.00 $0.00 $135.00
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: CKF Printed By: CKF Print Date: 5/21/02