2002, 06-24 Permit App: 02005079 Sewer Project Number: 02005079 Inv: 1 A ..,a 1cation Date: 6/24/02 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-SOUTH PONDEROSA Contact: H&S CONSTRUCTION
Address: 11817 E.VALLEYWAY AVE
C-S-Z: SPOKANE WA 99206
Setbacks:Front Left: Right: Rear: Phone: (509)926-8964
Group Name:
Site Information: Project Name:
Plat Key: 000875 Name: FOREST MEADOW ADD District: F
Parcel Number: 45333.0402 Block: Lot:
SiteAddress: 11012 E 43RD AVE Owner:Name: MCCLELLAND,JIM
SPOKANE,WA 99206 Address: 11012 E 43RD AVE
Location::SPO SPOKANE,WA 99206
Zoning: UNCL
Water District: Hold: ❑
Area: 0 Sq Ft Width: 121 Depth: 228 Right Of Way(ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Road Obstruction Released By: - 4_^QZ
oa
SKA-157(40
Permits: ...,.
Sewer Connection Permit
Contractor: H& S CONSTRUCTION Firm: H&S CONSTRUCTION
Address: 11817 E VALLEYWAY AVE Phone: (509)926-8964
SPOKANE,WA 99206
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: 6/24/02
Project Number: 02005079 Inv: 1 PP
A licatlhin Date: 6/24/02 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 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: 6/24/02