2011, 10-19 Permit: 11003217 RefundL2)
11703 E Sprague Ave Suite B-3 ♦ Spokane Valley WA 99206
♦ 509.720.5240 ♦ Fax: 509.688.0037 •
Memorandum
Date: 10/18/2011
To: FINANCE DEPARTMENT
From: JENNA DAVIS
CC: MARY KATE MCGEE
Re: REFUND - 6125 E MORELAND DR - ROW / PLUMBING PERMIT - ROW - SEWER
W/ 1 BLDG DRN CONN
PROJECT NUMBER: 11003217
PROJECT ADDRESS: 6125 E MORELAND DR
PROJECT TYPE: ROW/PLUMBING PERMIT
REASON:
REFUND TYPE:
GL ACCOUNT :
AUTHORIZED BY:
Refunding processing fee amount of $37 as it was charged in
error.
Per the currently adopted fee schedule, please refund the
applicant's visa in the amount of $37.
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DATE:
ORIGINAL TO FINANCE AND COPY TO FILE WITH PAPERWORK
1
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Stioliane
Permit Center
11703 E Sprague Ave Suite B3 Spokane Valley WA 99206
509.720-5240 ♦ Fax: 509.688.0037 ♦ email: permitcenter@spokanevalley.org
1
Site Information Project Information
Site Address: 6125 E MORELAND DR
Parcel Number: 35252.0913
Subdivision:
Block: Lot:
Zoning: R-2 SF Res Suburban District
Owner: JUST, CASEY W & CANDACE
Address: 6125 E MORELAND DR
SPOKANE, WA 99212-3231
Building Inspector: SOUTH
Water Dist: SPO CO WATER DIST#3A
Project Number: 11003217 Inv: 1 Issue Date: 10/11/2011
Permit Use: BUILDING DRAIN CONNECTION
Applicant: NORM'S Excavating
PO BOX 574
VERADALE, WA 99037 Phone: (509) 928-0580
Contact: NORM'S Excavating
PO BOX 574
VERADALE, WA 99037 Phone: (509) 928-0580
Setbacks - Front: Left: Right: Rear:
Group Name:
Project Name:
Permits
Plumbing Permit
Contractor: NORM'S EXCAVATING INC License #: NORMSEI972BM
PROCESSING FEE
FOR PLUMBING INSPECTIONS CALL (509) 688-0054.
$37.00 BUILDING DRAIN CONNECTI 1 $6.00
Total Permit Fee: $43.00
Right of Way
Contractor: NORM'S EXCAVATING INC License #: NORMSEI972BM
ROW - NO CUT OBS CLEANUP 1 $110.00
Total Permit Fee: $110.00
FOR RIGHT OF WAY INSPECTIONS CALL
(509) 869-5373 ENGINEERING
Payment Summary
Total Fees AmountPaid AmountOwing
$153.00 $153.00 $0.00
Tran Date
10/11/2011
Receipt # Payment Amt
28670 $153.00
Processed By: BONDURANT, MICK
Printed By: MORRIS, HEATHER Page 1 of 1
PERMIT
Valley
Community Development
Perrnit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Plumbing Permit Application
Nonn s Excavating, Ina11 L 8 j7 '91 JV 6 6: 6 UQ 6' L L'130
PO Box 574
Veradale, WA 99037
Fax: 892-0432
PERMIT NUMBER: I' 3 Z-)
7
PERMIT FEE: q 300
n Commercial ® Residential
SITE ADDRESS: 6125 F_ Moreland
3 c z5-2 o'9l
Building owner
DESCRIPTION OF WORK
Name: Just
Phone: 455-7722 Fax:
COST
Address: SAME
City: State:
Zip:
Contractor
WATER CLOSET, BIDETS
Name: Norm's Excavating, Inc
Phone: 509/928-0580
Fax: 509/892-0432
Address: PO Box 574
City : Veradale State: WA
Zip: 99037
License No: NORMSEI972BM
City Business License No:
$6.00
Contact
3
Name: Sheila Gibbons
Phone: 928-0580
X
10 ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56,00
11
12
FLOOR DRAINS
ROOF DRAINS/OVERFLOW
DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6.00
X
56.00
13
14
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
X
56.00
$6.00
6.00
15
SEWAGE EJECTOR
16
WATER USING DEVICE
GRINDER, SUMP PUMP
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
X
$6.00
17
CROSS CONNECTION DEVICE
18
INTERCEPTORS
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
19
20
MEDICAL GAS (per outlet)
MISCELLANEOUS PLUMBING
FIXTURE
NITROUS, OXYGEN
X
X
$6.00
56.00
21
22
PRIVATE SEWAGE DISPOSAL/SYS
INDUSTRIAL WASTE
INTERCEPTOR
METHOD OF PAYMENT:
0 CASH ❑ CHECK
Card# See Cover Sheet
AUTHORIZED SIGNATURE:
VISA 0 MASTERCARD
EXPIRES:
;
X
X
X
$6.00
820.00
$15.00
SUBTOTAL
6.00
PROCESSING FEE
TOTAL PERMIT FEE' DUE:
6.00
REVISED 8/26/05
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
LAVS/BASINS, BAR, FLOOR, KITCHEN,
SINKS LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
8
DISHWASHER
X $6.00 =
7
CLOTHES WASHER
X $6.00 =
8
GARBAGE DISPOSAL
X 86.00 =
9
WATER SOFTENER
X 86.00 =
10 ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56,00
11
12
FLOOR DRAINS
ROOF DRAINS/OVERFLOW
DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6.00
X
56.00
13
14
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
X
56.00
$6.00
6.00
15
SEWAGE EJECTOR
16
WATER USING DEVICE
GRINDER, SUMP PUMP
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
X
$6.00
17
CROSS CONNECTION DEVICE
18
INTERCEPTORS
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
19
20
MEDICAL GAS (per outlet)
MISCELLANEOUS PLUMBING
FIXTURE
NITROUS, OXYGEN
X
X
$6.00
56.00
21
22
PRIVATE SEWAGE DISPOSAL/SYS
INDUSTRIAL WASTE
INTERCEPTOR
METHOD OF PAYMENT:
0 CASH ❑ CHECK
Card# See Cover Sheet
AUTHORIZED SIGNATURE:
VISA 0 MASTERCARD
EXPIRES:
;
X
X
X
$6.00
820.00
$15.00
SUBTOTAL
6.00
PROCESSING FEE
TOTAL PERMIT FEE' DUE:
6.00
REVISED 8/26/05
• •,\..
Sikikane
.Valley
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Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date 10-20-2011 Permit # Account # 000122
ROW CONSTRUCTION PERMIT
Location of property 6125 E Moreland
(Address/Parcel #, if available)
Applicant Name Just
Address Same Fax 892-0432
Contractor's Name Norm's Excavating, Inc.
Address PO Box 574 Veradale, WA 99037 Phone 509/928-0580
Contractor's Reg# NORMSEI972BM Expires 01/14/13
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Sewer Connection Q Driveway
Curb & Gutter El Gas Installation/Repair
El Cable/Conduit/Pole Sidewalk Repair/Construction
I-7 Other
Pavement Cut
Dimensions
Bond/insurance certification must be on file with the City. Bond # 103957298
Permittee Signature Approved
Date
hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # See Cover Sheet
Name of Holder
Expiration Date
Signature
Fees Paid$ 110.00
(Application) (Inspection)
In addition to the permit application fee of $16.00 (utility) or $25.00 (construction), inspection on
each permit will be billed to the permittee at a rate of $50.00 per hour with a $25.00 (1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Date
snit
Work completed satisfactorily (Signed)
Permit not valid until One -Call Notification Ticket # entered here
Date
PERMIT MUST BE KEPT ON SITE