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2002, 10-11 Permit App: 02009012 Sewer, Plumbing Reversal Project Number: 02009012 Inv: 1 Application Date: 10/11/02 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: INT PLBG REVERSAL/SEWER Contact: ACME EXCAVATING CONNECT/WALNUT Address: 3021 N LILY RD C-S-Z: SPOKANE,WA 99212 Setbacks: Front Left: Right: Rear: Phone: (509)228-0691 Group Name: Site Information: Project Name: Plat Key: 001944 Name: PARKER'S SUB District: F Parcel Number: 45172.1338 Block: Lot: SiteAddress: 1013 N RUDOLF RD Owner: Name: SCARCELLO,DENNIS Spokane,WA USA 99206 Address: 1013 N RUDOLF RD Location::SPO SPOKANE,WA 99206-4031 Zoning: B-1 Neighborhood Business Water District: Hold: ❑ Area: 12,884 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: Review Road Obstruction Released By: .Aid4 �� `"� 4AS y. fa 4`7 Permits: Plumbing Permit Contractor: KEN CARTER Firm: KENNETH J.CARTER Address: 916 S UNIVERSITY RD Phone: (509)216-6539 SPOKANE,WA 99206 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 Operator: JAS Printed By: JAS Print Date: 10/11/02 Project Number: 02009012 Inv: 1 Application Date: 10/11/02 Page 2 of 2 THIS IS NOTA PERMIT Penalties will be assessed for commencing work without a permit Sewer Connection Permit Contractor: ACME EXCAVATING Firm: MAKE ORRINO/ACME EXCAVAT Address: 721 N LILY RD Phone: (509)228-0691 SPOKANE,WA 99212 Item Description Units Unit Desc Fee Amount SEWER CONNECTION 1 NUMBER OF $85.00 PROCESSING FEE 1 Y OR BLANK $15.00 Permit Total Fees: $100.00 Notes: Payment Summary: Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Plumbing Permit $35.00 $35.00 $0.00 $35.00 Sewer Connection Permit $100.00 $100.00 $0.00 $100.00 $135.00 $135.00 $0.00 $135.00 Disclaimer: Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for,or an approval of,any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: JAS Printed By: JAS Print Date: 10/11/02 Spokane County Division of Utilities SEWER CONNECTION PERMIT APPLICATION FORM PLEASE NOTE: This application form must be filled out accurately and in its entirety,and signed,or a permit will not be issued. Also note that sewer permits are valid for 12 months form the date of issuance. No extensions will be granted.'A separate right-of-way permit is required for any work performed in or from the county right-of-way. PROJECT INFORMATION Job Address: (6)/3 Owner's name: D��rir L/ _ .S G CC(fQ Parcel Number: i- S/7 Z•/3 3 f' Lot: Block: Project Name: Address: /0/3 /7 R tfe j IF Rs* ULID Name: City/State: Yfe-)�/"�f.}-•le i 4- i14 CHECK APPLICABLE BOXES Zip: C/�1Z_c� ‘ ❑ Regular v Residential O New ❑ Dry Sewer 0 Commercial 0 New Cf ❑ Repair 0 Temporary Phone: 2_t3 ���Z( ❑ Addition ❑ Abandonment * FIRST TIME CONTRACTORS OR HOME OWNERS PERFORMING THE INSTALLATION MUST FIRST CONTACT THE UTILITIES DIVISION BEFORE PERMIT(S)CAN BE ISSUED. SIGNATURE OF U"I'ILil'I[S DIVISION PERSON CONTACTED: Contra for(company name): Sate contractor license number: A-c,n�,.c C I--C-u./a wcl (-rvq CE 9 2 L-O Business address: 34)2 1 N ea�,� 4--A1 Contact Name: /^^ G921 ► I C5(f !'I�1� Cit,/State�'Y 7l)V- 2Q vY A Zip: Z - p _) Phone Number: 'Z� S INTERIOR PLUMBING ALTERATIONS? igr$' no) circle one Fill out the information in the table below if applica le** Contras e (i d_ifferet from above: Phone: Business Address: City/State/Z p I � 5. LiI r p©1v-ctric, orA q Q2o( **For plumbing reversal fee it formation,see reverse side of this form. FEE INFORMATION Number of Buildings connecting to sewer ( X (times)S100(per bldg)= S + S10-00= IiIGIIT UI \\U 1'I[R\IIT • Pur asingle-ramik r sid.ntial unit,one Permit is required; • I-or a eonduminium,ne,nhouse,duplex,triplex or fourples with separate ownership(as determined lax lot Imes)separate address and separate stub,one permit is required per address per smb, • or a single building duplex,triplex or f urples with single ownership,ime permit is required • Multiple buildings(apartments,industrial complexes)with single ownership,one permit required per building connecting to the seller. (FOR SITUATIONS NOT COVERED HERE,CALL THE COUNTY DIVISION OF UTILITIES AT 477-3604) Is any of the work to be performed in or from the county right-of-way? pti Yes 0 No .\PPI,IC:\N"l'SIGN.v1'URF:: D.VI'I.: Method of Payment: ❑ Cash 0 Check 0 Visa 0 MasterCard 0 Discover Card Date: l'xpires: liankcard Number: .Authorized Signature: PLUMBING PERMIT APPLICATION PROIFC} PERMIT ADDRESS: USE: OWNER: e PHONE (Daytime Contact): MAILING ADDRESS: (Street) (Cit~_/State) (Zip) CONTRACTOR: /� /o LICENSE: is s T, �� O G } �V' l l-�.r4e—� l Jim'-� 1 L. MAILING ADDRESS: PHONE: '2-1 (0 i 3q •r.I lift 6gP 0 ll ely)e . \Ai/A q q 2.06 (Scree„ (City/State) (Zip) PLUMBING FIXTURES I #OF MULTI- COST/ AMOUNT PLIED DESCRIPTION DETAIL UNITS BY UNIT EQUALS B02 T'011_ I:S WATER CLOSETS,BIDETS x $6 = B03 URINALS s SO = B04 TUBS - x $6 B05 SI IOWIERS(per trap) BATH,STALL,ON-SITE BUILD x SO _ BO6 SINKS LAN'S/BASINS,BAR,FLOOR, x SO = KITCHEN,LAUNDRY,UTILITY, JANI.I'OR,PHOTO,X-RAY,FOOD (PREP/CULINARY/MEAT B07 DISI!WAS)IER - z SO = B08 CLOT I IES WASI IER - x SO = B09 GARBAGE DISPOSAL/GRINDER - s SO = BIO WAFER R SOI'1•ENER - \ $6 B11 ELECTRIC IIOT WATER TANKS (NOTE: if gas water tank see mechanical) s SO = B12 FLOOR DRAINS AREA,CASE,COIL,TRENCI I, x SO = CONDENSATE B13 ROOF DRAINS/OVERFLOW DRAINS(ea.) - X SO = 1314 FOUNTAINS,DRINKING - x SO = 615 V\.VIER PIPING/DRAIN-IN WASTE.. INSTALLATION,ALTERATION, x SO = VENT/PLUMBING REVERSALS REP.\IR,REVI RSAI.S 1316 SEWAGE HECTORS GRINDER,SUMP PUMP y CO = 1317 \\.VI •P USING DEVICES ICE AND/OR COFFEE MAKER,I IOSF x S6 = BIB,STEAMER,PROOFER, CARBONATOR,SWAMP COOLERS B18 CROSS(:ONNI{CTTON DEVICES VACUUM BREAKER,CI IECK VALVE, S6 = AND R.P.B.P.D.FOR: VAI'S,SUMPS, TANKS,BOILERS,&SPRINKLER SYSTEMS BI9 IN l'1_R(.I•:I''I'ORS GREASE TRAP,SAND TRAP, . SO = CHEMICAL HOLDING TANK 1320 MI:DICAI.GAS(per outlet/bottle station) NITROUS,OXYGEN x SC _ B21 MISCI:1.1.:\NEOUS FIXTURES SO = METHOD OF PAYMENT SUBTOTAL tCOV== VISA PLUS PROCESSING ITE S 25.110 ❑ c.\SI I p ( 1IECK ❑ NEM ❑ ❑ =. 1-\\I(DPI tt\IF!.mut)\I.\ 131:.\CCP.I'ilN will]P.\S\IF:SI titS NI NI( R cr5t01 t:.(Rt) TOTAL\l.PI'R\11 T'I I'I•:IMF D.5'11-1: EXPIRES: MINIMUM PERMIT FEE IS$35.00 PLEASE\IAKI'.CHECKS P:\Y.\BI.li 10 B\N KC\RD NUNIBI•:R: SPOKANE COUNTY PERMIT CENTER _AUT11O1:1%I:1)SIGNATURE: Spokane Count'Division of Building&Code Enforcement 11120 West Broadway.Avenue' Spokane,WA 992011.111150 Telephone No.(509)477-3075*Fax No. 477-7198*TDD No. (509)477-7133