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2002, 05-13 Permit App: 02003625 SewerProject Number: 02003625 Inv: I Application Date: 5/13/02 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Prosect Information: Permit Use: SEWER CONNECTION - SOUTH PONDEROSA Contact: COURCHAINE CONSTRUCTION Address: 19818 E SPRAGUE C - S - Z: GREENACRES, WA 99016 Setbacks: Front Left: Right: Rear: Phone: (509) 924-5485 Group Name: Site Information: Project Name: Plat Key: CONV Name: CONVERTED CNTY DATA District: D Parcel Number: 44042.1423 Block: Lot: SiteAddress: 11219 E 48TH AVE Owner: Name: WAKE, BOB SPOKANE, WA 99206 Address: 11219 E 48TH AVE Location:: SPO SPOKANE, WA 99206 Zoning: SFR Water District: Hold: ❑ Area: 15,352 Sq Ft Width: 110 Depth: 139 Right Of Way (ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 1 Review Information: Review Road Obstruction Released By: 3 �' Permits:ar�a — - Sewer Connection Permit - Contractor: COURCHAINE CONSTRUCTION Firm: COURCHAINE CONSTRUCTION Address: 19818 E SPRAGUE AVE Phone: (509) 928-0846 GREENACRES, WA 99016 Item Description SEWER CONNECTION PROCESSING FEE Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Permit Total Fees: Fee Amount $85.00 $15.00 $100.00 Operator: CKF Printed By: CKF Print Date: 5/13/02 Project Number: 02003625 Inv: I Application Date: 5/13/02 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: CYCF Printed By: CKF Print Date: 5/13/02