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2001, 04-30 Permit App: 01002998 Sewer ti Project Number: 01002998 Inv: 1 Application Date: 4/30/01 Page 1 of 1 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SEWER CONNECTION-S PONDEROSA Contact: INLAND EMPIRE EXCAVATION Address: 10211 E.DRIFTWOOD C-S-Z: SPOKANE,WA 99206 Setbacks:Front Left: Right: Rear: Phone: (509)891-1586 Group Name: Site Information' Project Name: Plat Key: CONY Name: CONVERTED CNTY DATA District: E Parcel Number: 44042.0501 Block: Lot: SiteAddress: 4415 S SKIPWORTH ST Owner:Name: MERTENS,JERRY M SPOKANE,WA 99206 Address: 4415 S SKIPWORTH ST Location::SPO SPOKANE,WA 99206 Zoning: SFR Water District: Hold: ❑ Area: 12,600 Sq Ft Width: 140 Depth: 90 Right Of Way(ft): 0 Nbr of Bldgs: 1 Nbr of Dwellings: 0 Department Review ENGINEER Road Obstruction Released By: f 'f Cf d! Hold Reasons: Permit Conditions: .01 .51._42J 79 Sewer Permit Contractor: INLAND EMPIRE EXCAVATION Firm: INLAND EMPIRE EXCAVATION I Address: 10211 E DRIFTWOOD Phone: (509)891-1586 SPOKANE,WA 99206 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 Payment Summary: ,. 4 . Operator: DMD Printed By: DMD Print Date: 4/30/01 Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Sewer Permit $100.00 $100.00 $0.00 $100.00 $100.00 $100.00 $0.00 $100.00 Notes: Spokane Coutnty+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 p it is r required for any work performed in or from the county right-of-way. ',% L` C PROJECT INFORMATION Job Address: " l /5 J . 3/ i f_,-.9 01,44 `j Owner's name: �.y`/'(, i2C`7710,,0 j Parcel Number: Lot: Block: /,// ( �/ Project Name: Address: / 7 `S cJ JS e -,c-e_.) e"— ULID Name: / City/State: t, d.h 1.l� CHECK APPLICABLE BOXES � „A' Regular .frResidential O New Zip: /c�g 2© ❑ Dry Sewer O Commercial O New Phone: �A&` 13 7 z— ❑ Repair D Temporary ❑ Addition ❑ Abandonment Is any of the work to be performed in or from the county right-of-way? WYes* 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 CONTACTED: • Contractor(company name): , Sate contractor licens number i .r"- _1 . (c-11 CC o 66 �w Business address: f( _/ /`i Contact Name: - ^ - City/State: � �,Q i 1,144-- Zip:9923Sv I/VI 7 e Phone Number: 219/'" 45 5)i INTERIOR PLUMBING ALTERATIONS? (ye?circle one Fill out the information in the table below if applica Contractor(if different from above): Phone: Business Address: City/State/Zip "Toiidunibink reversal fee infimmation see reverse side of this form, ° "" .� " FEE INFORMATION Number of Buildings connecting to sewer X (times)$100(per bldg) = $ + $10.00 = 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 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 VERE ERE,C L THE C TY P SIO► OF UTILITIES AT 477-3604) APPLICANT SIGNATURE: /fit �� DATE: —_3 0 69J G' C� Method of Payment: ❑ 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 PERMIT ADDRESS: USE: OWNER: PHONE (Daytime Contact): MAILING ADDRESS: (Street) (City/State) (Zip) _ CONTRACTOR: LICENSE: MAILING ADDRESS: PHONE: (Street) (City/State) (Zip) PLUMBING FIXTURES #OF MUL77- AMOUNT PLIED DESCRIPTION DETAIL UNITS Ey UNIT EQUALS B02 TOILETS WATER CLOSETS,BIDETS x $6 B03' URINALS x $6 ................ B04 TUBS x $6 B05 SHOWERS(per trap) BATH,STALL,ON-SITE BUILD x $6 B06 SINKS LAVS/BASINS,BAR,FLOOR, x $6 KITCHEN,LAUNDRY,UTILITY, JANITOR,PHOTO,X-RAY,FOOD (PREP/CULINARY/MEAT B07 DISHWASHER x $6 = B08 CLOTHES WASHER - x $6 — B09,' GARBAGE DISPOSAL/GRINDER - x $6 BIG WATER SOFTENER x $6 B11 ELECTRIC HOT WATER TANKS (NOTE: if gas water tank see x $6 = mechanical) B12 FLOOR DRAINS AREA,CASE,COIL,TRENCH, x $6 = CONDENSATE B13 ROOF DRAINS/OVERFLOW DRAINS - x $6 = (ea.) B14 FOUNTAINS,DRINKING - x $6 B15 WATER PIPING/DRAIN-IN WASTE- INSTALLATION,ALTERATION, x $6 VENT/PLUMBING REVERSALS REPAIR,REVERSALS B16 SEWAGE EJECTORS GRINDER,SUMP PUMP x $6 = B17 WATER USING DEVICES ICE AND/OR COFFEE MAKER, x $6 = HOSE BIB,STEAMER,PROOFER, CARBONATOR,SWAMP COOLERS B18 CROSS CONNECTION DEVICES VACUUM BREAKER,CHECK $6 = VALVE,AND R.P.B.P.D.FOR: VATS,SUMPS,TANKS,BOILERS,& SPRINKLER SYSTEMS B19 INTERCEPTORS GREASE TRAP,SAND TRAP, x $6 = CHEMICAL HOLDING TANK B20 MEDICAL GAS(per outlet/bottle station) NITROUS,OXYGEN x $6 = B21 MISCELLANEOUS FIXTURES $6 METHOD OF PAYMENT SUBTOTAL 'UMW: VISA PLUS PROCESSING FEE $ 25.00 ❑ CASH ❑ CHECK ❑ nallin ❑ ❑ FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT OF A MAJOR CREDIT CARD TOTAL PERMIT FEE DUE DATE: EXPIRES: MINIMUM PERMIT FEE IS$35.00 PLEASE MAKE CHECKS PAYABLE TO BANKCARD NUMBER: SPOKANE COUNTY PERMIT CENTER 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