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2007, 05-03 Permit App: 07001591 ROW, Cross ConnectProject Number: 070111591 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/3/2007 Page 1 of 2 Project Information: Permit Use: ROW-LANDSCAPING,1 CROSS CONNECTION Setbacks: Front Left: Right: Rear: Site Information: Plat Key: Contact: HAASE LANDSCAPE, INC Address: 12202 E THORPE RD C - S - Z: SPOKANE WA 99206 Phone: (509) 926-7950 Group Name: Project Name: Name: Range District: East Parcel Number: 55181.4101 Block: SiteAddress: 17910 E MAXWELL AVE Location:: CSV Lot: Owner: Name: COLLINS, DENISE D Address: 17910 E MAXWELL AVE SPOKANE VALLEY, WA 99016 Zoning: UR -3.5 Urban Residential 3.5 Water District: 134 CONSOLIDATED ID #19 Hold: ❑ Area: 13,300 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information • Review Building Plan Review Released By: Other Reviews Permits• Released By: Contractor: HAASE LANDSCAPE, INC Address: 12202 E THORPE RD SPOKANE WA 99206 Item Description Plumbing Permit Firm: HAASE LANDSCAPE, INC Phone: (509) 926-7950 Units Unit Desc CROSS CONNECTION DEVICES 1 NUMBER OF Operator: jmm Printed By: jmm Fee Amount $6.00 Permit Total Fees: $6.00 Print Date: 5/3/2007 Project Number: 070(11591 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/3/2007 Page 2 of 2 Right of Way Contractor: HAASE LANDSCAPE, INC Firm: HAASE LANDSCAPE, INC Address: 12202 E THORPE RD Phone: (509) 926-7950 SPOKANE wA 99206 Item Description ROW - NO CUT OBS CLEANUP ROW - TRFC CTRL PLN REV Units Unit Desc 1 SELECT 1 SELECT Fee Amount $105.00 $50.00 Permit Total Fees: $155.00 Notes: Payment Summary: Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Plumbing Permit $6.00 $6.00 $0.00 $6.00 Right of Way $155.00 $155.00 $0.00 $155.00 $161.00 $161.00 $0.00 $161.00 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 construed 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: jmm Printed By: jmm Print Date: 5/3/2007 nn Permit Center Spokane 11703 E Sprague Ave, Suite B-3 Spokane Valley, WA 99206 alley (509)688-0036 FAX: (509)688-0037 www spokanevalley.org, r—\ Community Developm IEl l fr" '� u U ROW Constructs/ on l� PERMIT NUMBER: 1/-5-9 / PERMIT FEE: ❑ Driveway ❑ Pavement Cut **(see below) t Permit Application MAY 1. 2001 ❑ Sidewalk ❑ Curb & Gutter AN Other 0 Road Obstruction ❑ No [Yes (traffic control plan required) nlnnnu fi(1I11\vd PRUJELI AUL/KESS t ---e Tema F^ Nfc, (( START DATE 5/770 ? L ANTICIPATED COMPLETION DATE 5/9(d 7 Building Owner: Name: 'Deh,Ece Address: Vi S to State: yew Zip: eigeg L City: *1Vreri est Jeri Phone: l\ Fax: Contact Person lJry.t) Cr Ce(t Name: Phone: - **MUST BE COMPLETE IF PAVEMENT CUT** Contractor: Name: Lair ct s Ceti Address: (2Lei t E-Tlnofee VJ City: 5e�( State: Zip:C(ct2dt Phone: Sjo'i-426,.-7`iia Fax: 6d - (2c-ni Contractor Lic No: Exp Date: City Business Lic. No: Tier Policy Type of Work Condition of Cut Gas Sawcut Electric Grind (pre -approved only) Water CATV Communications Se ter Type of Repair Existing Road Condition Asphalt Depth of Asphalt Concrete Depth of Gravel Asphalt Width Length X X X Concrete Width Length X X X Locate Ticket # BOND/INSURA CE CERT # (PER SVMC TITL 10 ARTICLE 2) 572/'7 Signature Method of Payment: In Cash Bankcard #: Authorized Signature: ❑ Check ❑ Mastercard Expires: Date ❑ VISA VIN#: Work completed satisfactorily Date (INSPECTOR) PLEASE FAX TO CITY OF SPOKANE VALLEY UPON COMPLETION (509)688-0037 REVISED 16)25)05 Permit Center SpokanetaseN11707 E Sprague Ave, Suite 106 Walley Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 Community Development www snokanevallev.ore Plumbing Permit Application ❑ Commercial ;Residential PERMIT NUMBER: PERMIT FEE: SITE ADDRESS• Building Owner Name: De N X C.0/1A45 Phone: Fax. Address: I 7 110 �A E MC.K1.,c,ii City SIOOJCo.n4 1)4/(L/ State: //al/.) Zip. Contractor ;:. = .'; - ..:e_ ;• Name. aPhone: gz.c Fax: Address: -uw I z ./-a F-. Tom: �� City:' s OK q,,,t-t L 'o- HG r State: t.✓A Zip. C79 LU6 License No: P City Business Lie: '. ,Contact. . .. _ _,.,. y .. ..r ,. _ �. -,- 1 _ Name: Phone. DESCRIPTION OF WORK # OF UNITS X COST TOTAL AMOUNT 1 TOILETS WATER CLOSET, BIDETS X $6.00 2 URINALS X $6.00 3 TUBS X $6 00 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT X $6 00 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY. FOOD, PREP/CULINARY MEAT X $6.00 6 DISHWASHER X $6.00 7 CLOTHES WASHER X 56.00 8 GARBAGE DISPOSAL X 56 00 9 WATER SOFTENER X $6 00 10 ELECTRIC HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL X $6.00 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6 00 12 ROOF DRAINS/OVERFLOW DRAINS X $6 00 13 FOUNTAINS, DRINKING X $6 00 14 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL NSTALLATION, ALTERATION, REPAIR, REVERSALS X $6 00 15 SEWAGE EJECTOR GRINDER, SUMP PUMP X $6 00 16 WATER USING DEVICE ICE AN/OR COFFEE MAKER, HOSE BIB, STEAMER PROOFER, CARBONATOR, SWAMP COOLER X $6.00 17 CROSS CONNECTION DEVICE VACUUM BREAKER, CHECK VALVE, AND R P.B P.D. FOR' VATS, TANKS, BOILERS X. $6 00 6- c'o 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X 56 00 19 MEDICAL GAS (per outlet) NITROUS, OXYGEN X 5600 20 MISCELLANEOUS PLUMBING FIXTURE X 56 00 21 PRIVATE SEWAGE DISPOSAUSYS X $20 00 22 INDUSTRIAL WASTE INTERCEPTOR X 51500 METHOD OF PAYMENT: DCASH D CHECK D VISA DMC Card# AUTHORIZED SIGNATURE: REVISED 8/26/05 EXPIRES: VIN: SUBTOTAL PROCESSING FEE 535.00 TOTAL PERMIT FEE DUE: gi.00" 5u6N11 t FOP— A4 P e-CCAK atee CA -0 S A43((JG- ° (3'{ : wora- H fsT 1z 1c0�1 t> ss� P 2 CeS G1OCAC tD4-T o MaJ, 1113-n4Yt3 u3ats. 9 Time : By NoOPJ oN I--koK.n)' P(G� u6' 1 ri-1 u.l '31 JGSC){ 5099223332 w m CYO 05/03/2007 t,.1 01- ' POT- -ro 5c Sic s ;k 13A iP_ C C Lic / [J b n V/ site r' D, ct osc • A -F -ti ) i c- t6 G3/o © RC)AO CAL)A4--1--9,0 lib K4S 1370 0 pox° coasco-lc•t1-t40, s (vz-w-e1C GvOg_30 C`afv! tT] -r PC -it BrW2 ? .ca,oe W/putk-sL.14 i& U (3!—(T Postit° Fax Note 7671DaM ( 3 f 0I Imps ( To a1,-..16-41.-- NO-t� From l-1 ti 1441-i>.l%(- CoiDepl c.4, -r-; U e 50). J0.4.4... Co. N 0 f' -n -O. Sf '✓'— Phone 6 Phone N Fora Lief?— 0031 Foxy 4L�-333Z t,; 0 a 5099223332 MAY 03 2007 Sji kerne 4 ley 11707 E Sprague Ave Suite 106 ♦ Spokane Valley WA 99206 509.921.1000 ♦ Fax: 509.921.1008 ♦ cityhall@spokanevalley.org TCP Review To: Northstar Fax: 922-3332 CC: Re: Haase Landscaping From: Inge Note — Senior Traffic Engineer Pages: 9__ Date: 5/4/07 The traffic control plan submitted for the above referenced work has been APPROVED AS NOTED below. By: 1 ngNote, PE/PTO Date: Notes: 1. The traffic control plan submitted has been approved for concept only. The contractor is responsible for determining specific signing and layout as required by the Manual on Uniform Traffic Control Devices, WSDOT specifications, and Washington State modifications to the MUTCD. All devices shall conform to the MUTCD and WSDOT specifications. 2. The contractor shall notify Gay James, Public Works Administrative Assistant, by noon on Thursday of the week before commencement of road work. Her notification must include the location of the work, expected start and end dates, and dates and times of any road closures or delays. Gay can be reached at 688-0171 or giames(c�spokanevallev.orq and she will notify the newspaper, school districts, Spokane Valley police department, and fire dispatch as necessary. 3. The City of Spokane Valley may request changes as warranted by traffic conditions and motorist behavior.