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2002, 05-21 Permit App 02003911 SewerProject Number: 02003911 Inv: 1 `Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: ........ ....... ....... Permit Use: SEWER CONNECTION - EASTON Date: 5/21/2002 Page 1 of 2 Contact: INLAND EXCAVATING & CONSTRUCT Address: 3417 W OLSON RD C - S - Z: DEER PARK, WA 99006 Setbacks: Front Left: Right: Rear: Phone: (509) 276-8500 Group Name: Site Information: Project Name: ............... Plat Key: 001835 Name: OPP.TR. 1-354 District: Parcel Number: 45163.0105 Block: Lot: SiteAddress: 11316 E BROADWAY AVE Owner: Name: LISENBEE, JACK C SPOKANE, WA 99206 Address: 11316 E BROADWAY AVE Location:: SPO SPOKANE, WA 99206 Zoning: UR-3.5 Water District: Urban Residential 3.5 Hold: ❑ Area: 0 Sq Ft Width: 74 Depth: 199 Right Of Way (ft): 0 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Review Road Obstruction Permits: S Sewer Connection Permit Contractor: INLAND EXCAVATING & CONST Firm: INLAND EXCAVATING & CONST Address: 3417 W OLSON RD Phone: (509) 276-8500 DEER PARK, WA 99006 Item Description SEWER CONNECTION PROCESSING FEE Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Fee Amount $85.00 $15.00 Permit Total Fees: $100.00 Operator: RMB Printed By: RMB Print Date: 5/21/2002 Project Number: 02003911 Inv: 1 Application THIS IS NOT AllIERMT Date: 5/21/2002 Page 2 of 2 Penalties will be assessed for commencing work without a permit Payment Summary: Permit Type Sewer Connection Permit Fee Amount Invoice Amount $100.00 $100.00 Amount Paid $0.00 Amount Owing $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: 5/21/2002