2001, 07-18 Permit App: 01005861 SewerProject Number: 01005861 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 7/18/2001 Page 1 of 2
Project Information:
Permit Use: SEWER CONNECTION - SHELLEY LAKE PUD Contact: MORSE WESTERN HOMES, LTD
Address: 4616 S LINKE RD
C - S - Z: GREENACRES, WA 99016
Setbacks: Front Left: Right: Rear: Phone: (509) 927-9746
Group Name:
Site Information: Project Name:. .
Plat Key: 005862 Name: SHELLEY LAKE District: F
Parcel Number: 45242.1211 Block: 2
Lot: 11
SiteAddress: 613 S SHELLEY LAKE LN Owner: Name: MORSE WESTERN LTD
VERADALE, WA USA 99037 Address: 4616 S LINKE RD
Location:: VER GREENACRES, WA 99016-770
Zoning: UR -3.5 Urban Residential 3.5
Water District:
Hold: Lil
Area: 7,700 Sq Ft Width: 70 Depth: 110 Right Of Way (ft): 30
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Department
UTILITIES
Hol
Permit C ditions:
Permits:
Review
Review by Utilities
Contractor: JEWELL EXCAVATION
Address: 1819 S. SKIPWORTH
SPOKANE, WA 99206
Item Description
SEWER CONNECTION
PROCESSING FEE
Sewer Permit
Firm: JEWELL EXCAVATION
Phone: (509) 927-4217
Units Unit Desc
1 NUMBER OF
1 Y OR BLANK
Fee Amount
$85.00
$15.00
Permit Total Fees: $100.00
Project Number: 01005861 Inv: 1
r, s qE
Application Date: 7/18/2001 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Payment Summary::::
Operator: MKC
Permit Type
Sewer Permit
Printed By: MKC Print Date: 7/18/2001
Fee Amount Invoice Amount Amount Paid Amount Owing
$100.00 $100.00
$100.00 $100.00
$0.00 $100.00
$0.00
OCCUPANCY IS DENIED ON ALL LOTS UNTIL FURTHER NOTICE
FROM DIV. OF UTILITIES PER GENE REPP 3/26/97 CKF OK TO ISSUE
SEWER PERMITS FOR: BLOCK 2 - LOTS 3 THROUGH 10 & 1, 2
BLOCK 3 - LOTS 1 THROUGH 7 BLOCK 4 - LOTS 1 THROUGH 4
BLOCK 5 - LOTS 2 THROUGH
6 & 19 BLOCK 6 - LOTS 1 THROUGH 10
$100.00
Spokane County Division of Utilities
SEWER CONNECTION PE1 MIT 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:
/ 3 '
`f5 Xi/Z . /2// Lot: / ( Block: `Z --
CHECK APPLICABLE BOXES
❑ Regular
U Dry Sewer
❑ Repair
❑ Addition
❑ Abandonment
13—Residential O New
O Commercial O New
O Temporary
Owner's name:
Address: `(O % ('
City/State:
Zip:
Phone:
Is any of the work to be performed in or from the county right-of-way? 0 Yes*/1!1(No
* FIRST TIME CONTRACTORS OR HOME OWNERS PERFORMING' NSTA
UTILITIES DIVISION BEFORE PERMIT(S) CAN BE ISSUED.
SIGNATURE OF UTILITIES DMSION PERSON CONTACTED:
7
N MUST FIRST CONTACT THE
Sate contractor license number:
Business address:
City/State: Zip:
Contact Name:
Phone Number:
INTERIOR PLUMBING ALTERATIONS? (yes/no) circle one
Fill out the information in the table below if applicable**
Contractor (if different from above): Phone:
Business Address:
City/State/Zip
Number of Buildings connecting to sewer
• 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 building 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 HERE, CALL THE COUNTY DIVISION OF UTILITIES AT 477-3604)
FEE INFORMATION
X (times) $100 (per bldg) = $
+ $10.00 =
RIGHT OF WAY PERMIT
APPLICANT SIGNATURE: DATE:
Method of Payment:
O Cash
0 Check 0 Visa
0 MasterCard 0 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:
PST
USE:
OWNER:
PHONE (Daytime Contact):
MAILING ADDRESS:
(Street) (City/State) gip)
CONTRACTOR:
LICENSE:
MAILING ADDRESS:
PHONE:
(Street) (City/State) (Zip)
PLUMBING FIXTURES
DESCRIPTION
DETAIL
# OF
UNITS
MLn-
By
COST/
UNIT
EQUALS
AMOUNT
302:
TOILETS
WATER CLOSETS, BIDETS
x
S6
—
3d3
URINALS
x
S6
—
3
TUBS
-
x
S6
—
(per trap)
BATH, STALL, ON-SITE BUILD
x
$6
—
30SHOWERS
6
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD
(PREP/CULINARY/MEAT
x
S6
—
307 ,
DISHWASHER-
x
$6
—
308
CLOTHES WASHER-
x
$6
—
309
GARBAGE DISPOSAL/GRINDER-
x
$6
—
310
WATER SOFTENER-
x
$6
—
311
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank see
mechanical)
x
S6
—
312:
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
x
$6
—
313'.
ROOF DRAINS/OVERFLOW DRAINS-
(ea.)
x
S6
—
34r='
FOUNTAINS, DRINKING-
x
$6
—
315';
WATER PIPING/DRAIN-IN WASTE-
VENT/PLUMBING REVERSALS
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
x
S6
—
316'+
SEWAGE EJECTORS
GRINDER, SUMP PUMP
x
S6
—
317-
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLERS
x
$6
—
318`"
CROSS CONNECTION DEVICES
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR :
VATS, SUMPS, TANKS, BOILERS, &
SPRINKLER SYSTEMS
S6
3191
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
x
$6
—
320 `
MEDICAL GAS (per outlet/bottle station)
NITROUS, OXYGEN
x
$6
—
321
MISCELLANEOUS FIXTURES
56
—
v1ETHOD OF PAYMENT
........._ .... _.........
SUBTOTAL
PLUS PROCESSING FEE
S 25.00
] CASH ■ CHECK
FAXED PERMITS
)ATE:
•
WSA
IIIIIIINII.
WILL ONLY BE
OF A MAJOR CREDIT
EXPIRES:
■
ACCEPTED
i
"?
�''_ ■
WITH PAYMENT
CARD
tic,
TOTAL PERMIT FEE DUE
MINIMIIM PE, RJI IT FEEIS $35.00'
PLEASE MAKE- CHECKS PAYABLE TO
SPOKANE COUNTY PERMIT CENTER
SANKCARD 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