2003, 08-29 Permit App: BLD-03-02356 Addition0",o,
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
i
STREET ADDRESS: - `'f 0 ? /4-1 rA' '
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
a )MELDING PERMIT CHANGE IN .USE f GRADING 0 MANUFACTURE s .HOME
® OTHER
® RELOCATION
01 SIGN ® TENANT
OWNER / APPLICANT INFORMATION
OWNER: ' YA-ONr'r' s CANA' S `.
® APPLICANT:
PHONE: $ 27? f FAX: PHONE: FAX:
Vr
ADDRESS: 1 ' 1.01 O y Way ` V ADDRESS:
CITY,STATE, ZIP CITY, STATE, ZIP
®CONTRACTOR: ® ARCHITECT:
PHONE: FAX: PHONE:
ADDRESS: ADDRESS:
CITY,. STATE, ZIP
FAX:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE a# CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 400 - 03 30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS:
GARAGE:
DATE:
STAFF
METHOD OF PAYMENT:
CASH CHECK
BANKCARD *; EXPIRES: VIN #
VISA
ammion
AUTHORIZED SIGNATURE'
*GANGA ncn••n- • nn. in •wL0111.1c. ••uu 1 fl•u v nr •
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FROM : NORM'S EXCAVATING
FAX NO. : 509 B92 0432 Aug. 25 2003 12:38PM P2
ION
PROJECT % 1
ADDRESS: 9/�/ ? 7 6. V f7 LI- C
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PERMIT
USE:
PHONE(DaybmerCOTdaet): IP iiii
Orert arcs-
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OWNER: 1Coq . -
MAILING ADDRESS: SAME
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{street)
/
Jcitp/state)
UCENSE0:
&ELNFPH?*()�1D6
(Zip)
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CONTRACTOR:
Belknap Plumbing
fAAILNG ADDRESS:
3414 S. Adams Rd.
Verdale,
PHONE It:
921-5913
k..
WA99037
-
(street)
(city/state)
(zip)
DAZE:
RAN ARD HIMMEL - - -
ATTTHrIR17WTI CN:NA TT TR TR,
DEXRiPTMM
IMAMS
Orert arcs-
Y
I:QS ,
;QUAL% ,
AMOUNT -
1
TOILETS
WATER CLOSET, BIDETS
/
X
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-
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2
URINALS
k..
SEL
-
3
Tues
X
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-
4
SHOWERS (PER TRAPS
= ItSTALL ON.BITE BUILT
X
SS
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SINKS
= = = BEAR; FtE10R;
KITCHEN. LAUNDRY. UT1UTY,
JANITOR; PMQTO; X 4T FOOO,
PREPICU11NARY/MEAT
r
X
is
-
?D.00
6
7
DISHWASHER
X
-
CLOTHES WASHER
X
SEI
-
a
GARAGE DISPOSAL-
X_
86
-
s
WAT2R SOFTENER
_
X
:6
-
10
ELEC HOT WATER TANK
NOTE: IF GAS SEE MECHANICAL
X
36
-
11
FLOOR DRAINS
AREA, CAGE; COIL, TRENCH,
CONDENSATE
X
iB
-
12
FOUNTAINS, DfIRIVRG
X
Ni+r
-
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13
WATER PIPING/DRAIN-IN
WASTE, VE
PLUMBING REVERSAL
INSTALLATION, ALTERATION,
- -� �_
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-
14
SEWAGE EJECTOR
GRIN0E01,r PUMP
X
ie
-
15
WATER USING DEVICE
ICE
HOGE BIB, STEAMER, PROOFER,
r1:.'.r .1:SS 11 ICU P "C OMER
X
$6
16
CROSS CONNECTION
DEVICE
CUUIREPZieSEA."CHECK-
VALVE, AND R.P.B.P.D. FOR
w 8ti StUMP& TI,N s eoILEAS-
i6
17
SPRNKLER SYSTEM
X
$25
1a
INTERCEPTORS
.e,-..,-•;. ir,- -,SeiellERAP,NIB
CHEMICAL. WILDING Ma-
x
-
10
MEDICAL GAS per outlet
..,,• . - •, • GEN.
X-
36
-
20
MSC PLUMBING FIXTURE
X
Se
-
-
SUBTOTAL
PLUS PROCESSING
FEE
$ 35.00
• CASH • CHECK
D_ . -
LL ONClIIS1C
oP11MAJOR =WTCCARD --
PA»DPmCKIITV
TOTAL PERMIT FEE
DUE
DAZE:
RAN ARD HIMMEL - - -
ATTTHrIR17WTI CN:NA TT TR TR,
Project Number: 03006161 I(u'v: 1 issue Date 8/27/2003
Permit Use: SEWER CONNECTION - WALNUT
Applicant: NORM'S EXCAVATING
P.O. BOX 574
VERADALE, WA 99037
Contact: NORMS EXCAVATING
P.O. BOX 574
Phone: (509) 928-0580
VERADALE, WA 99037 Phone. (509) 928-0580
Setback - Front: Left: Right: - Rear. .
Permits
Contractor: NORMS EXCAVATING INC
Group Nainc:
Project Name:
License #: NORMSEI972BM
SEWER CONNECTION
1 535.00 PROCESSING FEE
515.00
Total Permit Fee: 5100.00
FOR SEWER INSPECTIONS CALL (509) 477-3604 UTILITIES p0-5.:00 PM MONDAY THRU FRIDAY
Call for inspection prior to cover. ONE WORKING DAY NOTICE REQUIRED.
Contractor or applicant is to field locate and confirm the elevation and position of sewer stub prior to any other excavation.
Sewer stubs are to be chcckrd prior to connection to ensure that they have acceptable grade and arc clear and unobstructed to the main sewer.
Sewer lines should he constructed to allow for gravity flow from the lowest level of the structure.
This permit must be presented to the job site inspector for verification. To locateburied cables, gas piping, water lino, ctc.
CALL BEFORE YOU DIG, (509)456-8000.
STATE LAW RCW 19.122 REQUIRES THAT PRIOR TO ANY EXCAVATION THE "CALL BEFORE YOU DIG" CENTER BE
NOTIFIED. CALL BEFORE YOU DIG AT LEAST.2, WORKING DAYS IN ADVANCE; (509)456-8000.
Spokane County Code requires the installer complywith all requirementsof the Washington State Dept of Labor and Industries, including
those related to trench safety.
E0 ' 30Ud
E2P0 E68 60S
£O:Pt EOOE 9E 8nd
Site Address: 9407 E VALLEYWAYAVE
SPOKANE. WA 99206
Parcel Number: 45173.0722
Subdivision: RAWLINGS SUB TR 102 OP?
Block Lot
Zoning: UR 3
Owner: CHASE, MORRIS Q. JR.
Address: 9407 E VAT-LEYWAY AVE
SPOKANE, NE, WA 99206
Budding Inspector: BOBBY STONE
Water Dist:
Sewer Connection Permit
1
Payment Summary
Total. Fees AmnuntPaid AmountOwing
5100.00 5100.00 50.00
an bate Receipt # Payment Amt
8/27/2003 5460 5100.00
Processed By: SHATTO, JULIE
Printed By: CARVER, LAURIE Page 1 of 1
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PERMIT
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