2001, 07-06 Permit App 01005470 Dryline SewerProject Number: 01005470 Inv: 1 Appli.mtion
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 7/6/2001 Page 1 of 1
Project Information: . .
. . . . . ........ . . .
Permit Use: DRYLINE SEWER - SHELLEY ACRES ADD Contact: LEXINGTON HOMES
Address: 12218 NEZ PERCE LN
C - S - Z: SPOKANE WA 99206
Setbacks: Front Left: Right: Rear: Phone: (509) 924-1519
Group Name:
Site Information: Project Name:
Plat Key: 005705 Name: SHELLEY ACRES District: F
Parcel Number: 45244.1006 Block: 1
SiteAddress: 1019 S COURTNEY LN
VERADALE, WA USA 99037
Location:: VER
Zoning: SR-1
Water District:
Suburban Residential 1
Area: 1.01 Acres Width: 0
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Lot: 6
Owner: Name: SHELLEY ACRES SUBDIVISI
Address: 14522 E VALLEYWAY AVE
SPOKANE, WA 99206
Hold: 0
Depth: 0 Right Of Way (ft): 30
Ret,iew Information: .
Department Review
UTILITIES Review by Utilities
Hold Reasons:
Permit Conditions:
Permits:
Released By:
12_1 I t;t02 62kA)24-- avi
Sewer Permit
Contractor: FOLSOM EXCAVATING INC Finn: FOLSOM EXCAVATING
Address: 16701 E VALLEYWAY AVE Phone: (509) 891-1232
VERADALE, WA 99037
Item Description
SEWER CONNECTION
PROCESSING FEE
Operator: MKC
Permit Type
Sewer Permit
Units Unit Desc
1 NUMBER OF
1 Y OR BLANK
Printed By: MKC
Fee Amount
$85.00
$15.00
Permit Total Fees: $100.00
Print Date: 7/6/2001
Fee Amount Invoice Amount Amount Paid Amount Owing
$ 100 . 00 $100.00
$0.00 $100.00
$100.00 $100.00 $0.00 $100.00
FLOOD PLAIN WATER DIST REQ'D FIRE DIST REQ'D
►SpG;51 1K`,r 0117Y: *1: vision 02 Utllities cr o �✓(My xxrC,Y.. . ,�� a.<
SEWER CONNECTION PERMIT
APPLICATION FORM
PLEASE NOTE: This application form must be filled out accurately and in its entirety, and signed, or a permit will not be issued.
Also note that sewer permits are valid for 12 months from the date of issuance_ No extensions will be granted.
PROJECT INFORMATION
Job address: I Dry Line Owner's name: / l
rig ,er? �i �cx/ 7'7c/a?aS, /x 'L •
.-
City: () a ' n City/State: Sf � G -A
zip: ` �� Zip: Cg 0o�
Parcel number (ifknown):
l'is5f '
Phone: (69) 924,--15/9
First-time contractors or home -owners performing the installation must first contact the utilities department (in person or via phone
[456-3604J) before a permit can be issued.
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Contractor (company name):
Business address:
6-- /Co 7of ( c -1 y
City/State: o_DA.
Zip: 9.a3'7 Phone: ( 9) 6 9/ --/& 2-
State contractor license number:
��L5OE0�37�Lt
Contact Name:
Phone: (6 09) 9.7 (o.01)Z
INTERIOR PLUMBING ALTERATIONS? (yes/no) circle ono
Fill out the information in the table below if applicable**
Contractor (if different from above): Phone:
Business Address:
City/State/Zip:
FEE INFORMATION
Sewer Connection: Number of Buildings / X(ti ) $100 (perbldg) = $ /OO
TOTAL FEE
• For a single-family residential unit, one permit is required;
-• For a condominium, townhouse,' duplex, triplex or fourplex with separate ownership (as determined by lot lines) separate
address and separate stub, one permit is required per address per stub;
• For a single building duplex, triplex or fotaplexwith single ownership, one permit is required
• Multiple buildings (apartments, industrial complo-r•s) with single ownership, one permit required per building connecting to
the sewer.
(For situations not covered here, call the County Division of Utilities @ 456-3604)
APPLICANT SIGNATURE:
Date: /- 2- GI :-✓
Return to:
Spokane County Division of Building dr Planning
West 1026 Broadway Avenue * Spokane, Washington 99260
PHONE: (509) 456-3675 * FAX (509) 324-3198 * TDD: (509) 324-3166
Spokane County dote not ds-^momace on the bans of damb they m the ,dno 000 to. of aeacmcat cc employment at if: program oe *cavities. cetwaces, ..eµ