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2002, 05-28 Permit App: 02004135 SewerProject Number: 02004135 111v: I A -npl-* I dt I'vp ic ion* Date: 5/28/2002 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Proiect Information: Parcel Number: 44042.1813 Block: SiteAddress: 10717 E 48TH AVE, SPOKANE, WA 99206 Location:: SPO Zoning: SFR Water District: Area: 0 Sq Ft Width: 0 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Revi, Roa( Lot: Owner: Name: BRAYTON, DARYL & BETTY Address: 10717 E 48TH AVE SPOKANE, WA 99206 Hold: F] Depth: 0 Right Of Way (ft): 50 Permits: ......................................................... - ...... ................... . ................... I ......... ............... . - ........ .... . .. ..... Sewer Connection Permit Contractor: SHORT SEPTIC SERVICE INC Firm: SHORT SEPTIC SERVICE INC Address: 3350 WILLIAMS RD E Phone: (509) 639-2393 ALNURA WA 99103 Item Description SEWER CONNECTION PROCESSING FEE Units Unit Desc Fee Amount I NUMBER OF $85.00 1 Y OR BLANK $15.00 Permit Total Fees: $100.00 Operator: RMB Printed By: RNIB Print Date: 5/28/2002 Project Number: 02004135 Inv: I Application Date: 5/28/2002 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Notes: :: Payment Summary: ry 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: RMB Printed By: RMB Print Date: 5/28/2002