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2000, 10-30 Permit App: 00009970 Sewer, Plumbing ReversalProject Number: 00009970 Inv: 1 Application Date: 10/30/2000 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 - WOLFLAND & PLUMBING REVERSAL Setbacks: Front Left: Right: Rear: Site Information: v>==ted-,� vv.^�.•�'o- ,+a �w-�ti� r r. , ,-,raw.�ti�awrs,�r �3 Plat Key: 001625 Name: MICHIELLI PARK WflANWM Contact: Z BEST CONSTRUCTION Address: P.O. BOX 13421 C - S - Z: SPOKANE WA 99213 Phone: (509) 891-9949 Group Name: Project Name: District: H Parcel Number: 45074.0448 Block: SiteAddress: 8720 E MICHIELLI PL SPOKANE, WA USA 00000 Location:: SPO Zoning: B-2 Water District: Community Business Area: 10,083 Sq Ft Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: Lot: Owner: Name: EDWARDS, DONNA Address: 8720 E MICHIELLI PL SPOKANE, WA 99212-2426 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Department ENGINEER Hold Reasons: Permit Conditions: Permits: Review Road Obstruction Rel_-_ Contractor: YOUNG'S PLUMBING Address: 342 W DALKE SPOKANE, WA 99205 Plumbing Permit Firm: DINO YOUNG'S PLUMBING Phone: (509) 489-6132 Item Description Units Unit Desc Fee Amount WATER PIPING - DWV 1 NUMBER OF $6.00 PROCESSING FEE 1 Y OR BLANK $25.00 MINIMUM FEE ADJUSTMENT 1 Select $4.00 Permit Total Fees: $35.00 Project Number: 00009970 Inv: 1 Application Date: 10/30/2000 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Sewer Permit Contractor: Z BEST CONSTRUCTION Firm: Z BEST CONSTRUCTION Address: P 0 BOX 13241 AVE Phone: (509) 891-9949 SPOKANE, WA 99213-3241 Item Description SEWER CONNECTION PROCESSING FEE Payment Summary: Operator: RMB Permit Type Plumbing Permit Sewer Permit Notes: Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Printed By: RMB Permit Total Fees: Fee Amount $85.00 $15.00 $100.00 Print Date: 10/30/2000 Fee Amount Invoice Amount Amount Paid Amount Owing $35.00 $35.00 $0.00 $35.00 $100.00 $100.00 $0.00 $100.00 $135.00 $135.00 $0.00 $135.00 Spokane County Derision of Utilities 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 form the date of issuance. No extensions will be granted. A separate right-of-way permit is required for any work performed in or from the county right-of-way. PROJECT INFORMATION Job Address: Parcel Number: Project Name: ULID Name: Lot: Block: CHECK APPLICABLE BOXES Regular ❑ Dry Sewer ❑ Repair ❑ Addition ❑ Abandonment Residential O New O Commercial O New O Temporary Owner's name: Address: City/State: Zip: Phone: %a(tvQrce& 7ao f. q9 O / Is any of the work to be performed in or from the county right-of-way?_ es* O No FIRST TIME CONTRACTORS OR HOME OWNERS PERFORMING THE INSTALLATION MUST FIRST CONTACT THE UTILITIES DIVISION BEFORE PERMIT(S) CAN BE ISSUED. SIGNATURE OF UTILITIES DIVISION PERSON CONTAC 1"ED: Contractor 7s4 ame)l- o il3 fruel) U Sate contractor licensnumber: f 0 77 K 1-1 Business address: City/State: Sp b C;(( Zip: r f 9 Contact Name: Phone Number: ©— "/ r INTERIOR PLUMBING ALTERATIONS?( no) circle one Fill out the information in the table below if applicable" Contractor (if different from above): Phone: Business Address: City/State/Zip *'For plumbing reversal fee informatzon; sWreversesud of this form, /� p� FEE INFORMATION /� Number of Buildings connecting to sewer /vv . G7 X (times) $100 (per bldg) _ $ /e)• O + $10.00 = fid - RIGHT RIGHT OF WAY PERMIT • 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 budding duplex, triplex or fourplex with single ownership, one permit is required • Multiple buildings (apartments, industrial complexes) with single ownership, one permit required per building connecting to the sewer. (FOR SITUATIONS NOT COVERED HE A THE COUNTY DIVISION OF UTILITIES AT 477-3604) APPLICANT SIGNATU LtriZDUY(...) Method of Payment: 0 Cash 0 Check 0 Visa 0 MasterCard DATE: /0 -30 -6 ❑ Discover Card Date: Expires: Bankcard Number: Authorized Signature: Spokane County Division of Building & Code Enforcement 1026 West Broadway Avenue " Spokane WA 99260 Tel. No. (509) 477-3675 " Fax No. (509) 477-7198 " TDD No. (509) 477-7133 PLUMBING PERMIT APPLICATION PROJECT -- ADDRESS: ` `%%1,%Jia��� ���" L PERMIT USE: OWNER: •n' /' otte,O PHONE (Daytime CQa`jtiv 5..._c 7 MAILING S:3' 7 0 L _ / 4 ,',)0' ' /Z X.,. aI 4 --- Street (City/State) (Zip) CONTRACTOR: Dt, �5 I t c .hi wa LICENSE. -kf o U n� -Y- 3-, e '� MAILING ADD' PHONE: .-3ci a 1". Q -Ji - >-) a. , - , . . _, (Street) /State (Zip) PLUMBING FIXTURES I DETAIL # OF UNITS MULTI — COST/ PLIDESCRIPTION sy UNIT EQUALS AMOUNT B02 TOILETS WATER CLOSETS, BIDETS x $6 — B03 URINALS x 56 B04 TUBS- x $6 = B05, SHOWERS (per trap) BATH, STALL, ON-SITE BUILD x 56 = B06' SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD (PREP/CULINARY/MEAT x S6 — B07 DISHWASHER - x $6 — B08 CLOTHES WASHER- x S6 B09 GARBAGE DISPOSAL/GRINDER- x 56 — B10" WATER SOFTENER- x 56 — B11 ELECTRIC HOT WATER TANKS (NOTE: if gas water tank see mechanical) x 56 — B12 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE x 56 B13 ROOF DRAINS/OVERFLOW DRAINS- (ea.) x $6 — B14 FOUNTAINS, DRINKING- x $6 B15 WATE' WIPING/ 11 / ,- ' 1. : TE- VEN hat 1. _ •_ • ALS - INSTALLATION, ALTERATION, REPAIR, REVERSALS x 56 = B16 SEWAGE EJECTORS GRINDER, SUMP PUMP x 56 — B17 WATER USING DEVICES ICE AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLERS x S6 = B18 CROSS CONNECTION DEVICES VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR : VATS, SUMPS, TANKS, BOILERS, & SPRINKLER SYSTEMS $6 = B19 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK x 56 — B20 MEDICAL GAS (per outlet/bottle station) NITROUS, OXYGEN x S6 = B21 MISCELLANEOUS FIXTURES 56 — METHOD OF PAYMENT SUBTOTAL PLUS PROCESSING FEE 5 25.00 VISA ■ CASH ❑ CHECK ■ ■ ■ FAXED PERMITS IX'ILL ONLY BE ACCEPTED WITH PAYMENT OFA MAJOR CREDIT CARD DATE: / EXPIRES: >iJClVE=- - _-- - -- TOTAL PERMIT FEE DUE �''`), Ca MINIMUM PERMIT FEE IS S35.00 PLEASE MAKE CHECKS PAYABLE TO SPOKANE COUNTY PERMIT CENTER BANKCARD NUMBER: AUTHORIZED SIGNATURE: Spokane County Division of Building & Code Enforcement 1026 West Broadway Avenue * Spokane, WA 99260-0050 Telephone No. (509) 477-3675 Fax No. 477-7198 " TDD No. (509) 477-7133