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2002, 06-10 Permit App 02004598 SewerProject Number: 02004598 Inv: .1 Application Date: 6/10/02 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SEWER CONNECTION - EASTON 2 Setbacks: Front Left: Right: Rear: Site Information: Plat Key: 001624 Name: MICHIELLI SUB Parcel Number: 45162.1158 Block: 72 SiteAddress: 11403 E BROADWAY AVE SPOKANE, WA USA 00000 Location:: SPO Zoning: UR-3.5 Water District: Urban Residential 3.5 Area: 11,195 Sq Ft Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: Review Road Obstruction Permits: �2sMt� 4cos- Contact: INLAND EXCAVATING & CONSTRUCTI Address: 3417 W OLSON RD C - S - Z: DEER PARK, WA 99006 Phone: (509) 276-8500 Group Name: Project Name: District: F Lot: 7 Owner: Name: GLOTH, ALAN J Address: 11403 E BROADWAY AVE SPOKANE, WA 99206-5013 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Released By: Sewer Connection Permit Contractor: INLAND EXCAVATING & CONST Address: 3417 W OLSON RD DEER PARK, WA 99006 Item Description SEWER CONNECTION PROCESSING FEE Firm: INLAND EXCAVATING & CONST Phone: Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Permit Total Fees: (509) 276-8500 Fee Amount $85.00 $15.00 $100.00 Operator: CKF Printed By: CKF Print Date: 6/10/02 Project Number: 02004598 Inv: 1 Notes: Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Payment Summary: Permit Type Sewer Connection Permit Date: 6/10/02 Page 2 of 2 Fee Amount Invoice Amount Amount Paid Amount Owing $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: CKF Printed By: CKF Print Date: 6/10/02