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2002, 05-21 Permit App 02003910 SewerProject Number: 02003910 Inv: 1 - - Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/21/2002 Page 1 of 2 Project Information: . . . . . . . . . . . . . . . Permit Use: SEWER CONNECTION - EASTON 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: Project Namc: Site Information: ....... . . . . ............... Plat Key: 001835 Name: OPP.TR 1-354 District: F Parcel Number: 45163.0107 Block: SiteAddress: 11320 E BROADWAY AVE SPOKANE, WA 99206 Location:: SPO Zoning: UR-3.5 Water District: Area: 0 Sq Ft Nbr of Bldgs: 1 Urban Residential 3.5 Width: 0 Nbr of Dwellings: 1 Lot: Owner: Name: ALLEN, LOREN Address: 11320 E BROADWAY AVE SPOKANE, WA 99206 Hold: [1] Depth: 0 Right Of Way (ft): 0 Review Road Obstruction Permits: c)-Zc-0 onv- Sewer Connection Permit Contractor: INLAND EXCAVATING & CONST Address: 3417 W OLSON RD Phone: (509) 276-8500 DEER PARK, WA 99006 Item Description SEWER CONNECTION PROCESSING FEE Firm: INLAND EXCAVATING & CONST Units Unit Desc 1 NUMBER OF 1 Y OR BLANK. Permit Total Fees: Fee Amount $85.00 $15.00 $100.00 Operator: RMB Printed By: RMB Print Date: 5/21/2002 Project Number: 02003910 Inv: I Application THIS IS NOT A Pi:RMIT Penalties will be assessed for commencing work without a permit Notes: Payment Summary::.;:.:;:.::::;.;:.; Permit Type Sewer Connection Permit Date: 5/21/2002 Page 2 of 2 Fee Amount Invoice Amount Amount Paid Amount Owing $100.00 $100.00 $100.00 $100.00 $0.00 $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