2002, 05-03 Permit App: 02003293 SewerProject Number: 02003293 Inv: 1
' Application
THIS IS NOT A PERMIT
Date: 5/3/02 Page 1 of 2
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: SEWER CONNECTION - DISHMAN COMMONS Contact: NORTHWEST REGIONAL FACILITATO
Address: 525 E MISSION
C - S - Z: SPOKANE WA 99202
Setbacks: Front Left: Right: Rear: Phone: (509) 484-6733
Group Name:
Site Information: Project Name:
Plat Key: 006123 Name: DISHMAN COMMONS
Parcel Number: 45291.1909 Block: 3 Lot: IIA
SiteAddress: 10004 E 17TH LN
SPOKANE, WA USA 99206
Location:: SPO
District: F
Owner: Name: NORTHWEST REGIONAL FACILI
Address: 525 E MISSION
SPOKANE WA 99202
Zoning: UR -3.5 Urban Residential 3.5
Water District: 100 SPO CO WATER DIST#3A Hold: ❑
Area: 4,550 Sq Ft Width: 45 Depth: 100 Right Of Way (ft): 32
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Review by Utilities
Permits:
Released By: N' C
Server Connection Permit
Contractor: NORTHWEST REGIONAL Firm: NORTHWEST REGIONAL FACILI
Address: 525 E. MISSION AVE Phone: (509) 484-6733
SPOKANE, WA 99202
Item Description Units Unit Desc Fee Amount
SEWER CONNECTION 1 NUMBER OF $85.00
PROCESSING FEE 1 Y OR BLANK . $15.00
Operator: JAS Printed By: JAS
Permit Total Fees: $100.00
Print Date: 5/3/02
j
Project Number: 02003293 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 5/3/02 Page 2 of 2
Notes:
Payment Summary
Permit Type Fee Amount
Sewer Connection Permit $100.00
$100.00
Invoice Amount
$100.00
$100.00
Amount Paid
$0.00
$0.00
Amount Owing
$100.00
$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:
5/3/02