2002, 10-11 Permit App: 02009013 Sewer, Plumbing Reversal, Piping, ROW Project Number: 02009013 Inv: I Application Date: 10/11/02 Page 1 of 2
THIS IS NUT 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: 001943 Name: PARKERS SUB.TR.57&58 OPP. District: F
Parcel Number: 45172.1328 Block: 2 Lot: 10
SiteAddress: 1022 N RUDOLF RD Owner:Name: RANKIN,WENDY S
SPOKANE,WA USA 99206 Address: 1022 N RUDOLF RD
Location::SPO SPOKANE,WA 99206-4031
Zoning: UNKN Unknown
Water District: Hold: ❑
Area: 11,230 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Review
- 71
Road Obstruction Released By:
14t) •• b 1---
sA se_e70
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: 02009013 Inv: 1 Application Date: 10/11/02 Page 2 of 2
THIS IS NOT A 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: � �l ,�'LS) /t Rd
_ Owner's name: _)C ?d' �2/?,,t.
Parcel Number: 4/571% L-+1 3„t 6 Lot: Block:
Project Name: wh/h J
Address: ld ,'der Rd.
OLID Name: `
City/State: '/ O 0YyiG-- rc_sof
CHECK APPLICABLE BOXES
U Regular � Residential 0 New Z'Pfr7 2 `)
❑ Dry Sewer 0 Commercial 0 New )
Phone: � L�!"' Ci/T2
❑ Repair O "Temporary
❑ 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 UTILITIES DIVISION PERSON CON'T'ACTED:
ContraAtor fk-C cc p name): 41f1� 6-1\4
�Sate contractor license number:E e)2-
)2BusBusiness
iness address: 3,402,1 JJ L_,11 Contact Name /, ;� /
City/State��i[OILC P/ v�l(q Zip: G 9 212 ►'� 1'fc - _ C)p(Tr;op
Phone Number 25 I eS
INTERIOR PLUMBING ALTERATIONS?19/no) circle one
Fill o»l the information in the table below if apphrca le**
Contract (i.edifferet from above): Phone:
L- r+ 2 "P — -7 (039
Business Address: City/State/Zip
t4, 5, � i I e��t O C�1� 1,,VA q q z O(c,
**For plain hing reversal fee ii formation,see reverse side of this form
FEE INFORMATION
Number of Buildings connecting to sewer N (times)S100(per bldg)=S + SI0.00=
Iil(:I rr 1)1 55\ PP:R\Ira
• Por a single-family residential unit,one permit is rcquireJ;
• Por a condominium,townhouse,duplex,triplex or(ourplex with separate ownership(as determined be lot lines)separate address and separate stub,one permit is required per address per smb;
• Por a single building duplex,triplex or tourples aaith single ownership,one permit is required
• i\lultiple buildings(apartments,industrial complexes)with single ow nership,one permit required per building connecting to the sewer.
(FOR SITUATIONS NOT COVERED HERE,CALL THE COUNTY DIVISION OF UTILITIES AT 477-3604)
Is any of the work to be performed in or flurn the county right-of-way? g Yes 0 No
\PPI.IC:\NI'SIGNATURE:
Method of Payment:
❑ Cash 0 Check 0 Visa 0 MasterCard 0 Discover Card
Date: I';spire.:
Iiankcard Number:
Authorized Signature:
PLUMBING PERMIT APPLICATION
PROJECT PER\11'1'
ADDRESS: USE:
OWNER: PHONE (Daytime Contact):
MAILING ADDRESS:
(Street) (City/Stare) (Zip)
CON:IR:1C1•OR: J(c l C– 1: ^ LICENSE:
MAILING ADDRESS: PHONE:
— 739
IP �: A VZ-1 _ WA- q 20h
(Stree', (City/State) (Zip)
PLUMBING FIXTURES
#OF MULTI- COST/ AMOUNT
PLIED
DESCRIPTION DETAIL UNITS BY UNIT EQUALS
B02 TOILETS WATER CLOSETS,BIDETS x $6 =
B03 URINALS $6 =
B04 TUBS x $6 =
B05 SI 10WERS(per trap) BATH,STALL,ON-SITE BUILD x $6 =
B06 SINKS LA\'S/BASINS,BAR,FLOOR, x $6 =
KITCHEN,LAUNDRY,UTILITY,
JANITOR,PI-IOTO,X-RAY,FOOD
(PREP/CULINARY/MEAT
B07 DISI IW:\SFIER - x S6 =
B08 CI MI IFS WASI IER - $6 =
B09 GARBAGE DISPOSAL/GRINDER - 56 =
B10 WATER SOITENER - N $6 =
Bl I ELECTRIC I:CT•RIC 110'1'WATER TANKS (NO.1T:: if gas water tank see mechanical) s S6 =
B12 FLOOR DR.\INS AREA,CASE,COIL,•IRENCI I, S6
CONDENSATE
B13 ROOF DRAINS/OVERFLOW"DRAINS(ca.) - S6 =
B14 FOUNTAINS,DRINKING - - S6
B15 WATER PIPING/DRAIN-IN WASTE- INSI\1.1.ATION,ALTERATION, ' SG =
VENT/PLUMBING RI•:\'F:RSAI.S REP.\IR,REVERSALS
B16 SEWAGE EJECI'ORS GRINDER,SUMP PUMP S6 =
B17 \\.VI FR USING DI(\•ICES ICE AND/OR COFFEE MAKER,I FOSE S6 =
BIB,STEAMER,PROOFER,
CARBONA I'oR,SWAMP COOLERS
B18 CROSS CONNF:CITON DEVICES VACUUM BREAKER,(:1IECK V'ALV'E, S6 =
AND R.P.B.P-D.FOR: A'.A'IS,SUMPS,
TANKS,BOILERS,&SPRINKLER
SYSTEMS
B19 INTTIRCI•:PT ORS GREASE TRAP,SAND TRAP, , S6 =
CI IEMICAI.HOLDING TANK
B20 MIE:DICAL.G.\S(per outlet/bottle station) NITROUS,OXYGEN N S6 =
B21 \IISCI I.I.ANI{OUS FIXTURES S6 =
METHOD OF PAYMENT SUBTOTAL
AL
NICOVER
VISA PLUS PROCESSING ITN S 25.11(1
❑ CASH ❑ clll:CK ❑ NM= ❑ D
I-(Ni )rr.1(\IFiStcn.t.ua.\ BF uxraPrro(SII Iii'
OF 5?I Aµ(a CRUM C utu "f0'L.AI.YI-:IO II I HT DUN
NP I RFS: MINIMUM PERMIT FEE IS$35.00
PLEASE\l.\KIE CiIECKS PAYABLE 7'0
B ANKC.ARD NUMBI•:R: SPOKANE COUNTY PERMIT C1_N'ITiR
-\1117 10RI%I:D SIGNATURE::
Spokane County Division of Building&Code NM-Ora-mem
1026 West Broadway.Avenue' Spokane,WA 99260-0050
Telephone No.(509)477-3675 Fax No. 477-7198`TDD No. (5(19)477-7133