2002, 10-11 Permit App: 02009011 Plumbing Reversal, SewerProject Number: 02009011 Inv: 1
Application
THIS IS NOTA PERMIT
Penalties will be assessed for commencing work without a permit
Date: 10/11/02 Page 1 of 2
Project Information:
Permit Use: INT PLBG REVERSAL/SEWER Contact: ACME EXCAVATING
CONNECT/MISSION 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: 001648 Name: MISSION ADD District: F
Parcel Number: 45172.0601 Block: 6
SiteAddress: 1315 N WOODRUFF RD
SPOKANE, WA USA 99206
Location:: SPO
Zoning: UNKN Unknown
Water District:
Area: 11,600 Sq Ft Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Review
Road Obstruction
6 asA-v.e4g
Permits:
Lot: 1
Owner: Name: BIPPES, DERRYL R
Address: 1315 N WOODRUFF RD
SPOKANE, WA 99206-3970
Hold: ❑
Depth: 0 Right Of Way (ft): 0
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
Operator: JAS Printed By: JAS
Permit Total Fees: $35.00
Print Date: 10/11/02
Project Number: 02009011 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 10/11/02 Page 2 of 2
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
SEWER CONNECTION
PROCESSING FEE
Notes:
Payment Summary:
Permit Type
Plumbing Permit
Sewer Connection Permit
Units Unit Desc Fee Amount
1 NUMBER OF $85.00
1 Y OR BLANK $15.00
Fee Amount
$35.00
$100.00
$135.00
Permit Total Fees: $100.00
Invoice Amount
$35.00
$100.00
$135.00
Amount Paid
$0.00
$ 0.00
$0.00
Amount Owing
$35.00
$100.00
$135.00
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: JAS Printed By: JAS
Print Date: 10/11/02
Spokane County Division of Utilities
SEWER CONNECTION PERMIT APPLICATION FORM
('LEASE NOTE: This application form must be filled out accurately and in its entirety, and signed, or a permit will not be issued. Also note that sewer permits are
valid for 12 months form the date of issuance. No extensions will be granted. A separate right-of-way permit is required for any work performed in or from
the county right-of-way.
PROJECT INFORMATION
Job Address: /3) cri iiiDDrie I..//Cc
Parcel Number 5/577).04,01 Lot: Block:
Project Name: Jfl,'5 Sr dry
ULID Name:
CHECK APPLICABLE BOXES
❑ Regular
❑ Dry Sewer
O Repair
O Addition
❑ Abandonment
O Residential
Ix Commercial
O Temporary
O New
O New
Owner's name:
Address:
City/State:
Zip:
Phone:
Pte./ 12$oer
/3/)`" h fa.00d2u&
v6
2.2-3/41?
* 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:
Cont ry for (company name):
Business address: -3'40% I 14 LA.+j .2-41
City/Stan: l[5Qj '- 4A Zip: q 92-12
Sate contractor A (. number:
cr. r - * E52 -
Contact
2
Contact Namc
ni-rf Cleo
Phone Number: '2E5 1 — Uc se)
INTERIOR PLUMBING ALTERATIONS?
Fill on/ ibe information in the table below if app11e /e
no) circle one
Contrac(ty i differs from;ibove: Phone: 21
cart e.4-
Business Address: City/State/'L"p
cj I to 5, l_ aer%I OIL-CLflci 1. VA q q 2,o(0
**For plumbing reversalfes information, see revere side oft is form.
Number of Buildings connecting to sewer
FEE INFORMATION
/ X (times) S100 (per bldg) = S + S10.00 =
Rim tr UP W.\1' ilia\In
• For a sin0e-family residential unix, unc permit is required;
• far a condominium, townhouse, duplex, triples or Jimmies with separate ownership (as determined by lot lines) separate address and separate snub, (Inc permit is required pc address per stub;
• For a sink building duplex, triples or fourplex with single ownership, one permit is required
• Multiple budding. (apartments, industrial complexes) with single ownership, one permit required per budding 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 from the county right-of-way? # Yes 0 No
.\Pl'I.1C:\N'I' SIGNATURE,
D.
Method of Payment:
0 Cash 0 Check 0 Visa 0 MasterCard 0 Discover Card
Date: I?spires:
Bankcard Number:
Authorized Signature:
PLUMBING PERMIT APPLICATION
PROII?CI
ADDRESS:
PERMIT
USG:
OWNER:
PHONE (Daytime Contact):
MAILING ADDRESS:
(Street) (City/State) (Zip)
C.ON"fR.•\CI'OR:
Kul C�,���L
LICENSE: CAre_ F KJ 0�' M 0
ML\II.ING ADDRESS:
PHONE:
2 1 (0 -- i 0 39
el tic) 5, UA4Vcrt,e 6pn>«ne . WA 4 q zoh
(Scree (City/State) (Zip)
PLUMBING FIXTURES I
DESCRIPTION
DETAIL
# OF
UNITS
MULTI-
PLIED
er
COST/
UNIT
epuntr
AMOUNT
B02
TOILF:I'S
WATER CLOSETS, BIDETS
x
56
=
803
URINALS
x
56
=
804
TUBS
-
x
56
=
B05
SI TOWERS (per trap)
BATH, STALL, ON-SITE BUILD
x
56
=
B06
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD
(PREP/CULINARY/MEAT
x
56
=
1307
DISI IWASI IER
-
x
56
=
B08
CLOTHES WASHER
-
x
56
=
1309
GARBAGE DISPOSAL/GRINDER
-
x
56
=
1310
W.\IHR SOFTENER
-
x
56
=
1311
1'.I.F(7R IC 110'1'WATEItTANKS
(NOTE: if gas water tank see mcchanicall
x
56
=
B12
FLOOR DRAINS
AREA, CASE, COIL, TRI I,54
CONDENSATE
_
1313
ROOF DRAINS/OVERFLOW DRAINS (ca.)
-
x
56
=
814
l-OUNI'AINS. DRINKING
-
x
54
=
815
WATER PIPING/DRAIN-IN WASTE;
\'ENI'/I'L.UMBING RI•:\'IiRS.\7 S
INSI'.\1LATION, AL1ERATION,x
RI'.P.\It, RE\'I RSAIS
i
56
=
816
SIS\Y'.\GF RIECJORS
GItINDIC.R, SUMP PUMP
x
56
B17
\\'.VIY.It USING DEVICES
ICE AND/OR COFFEE MAKER, I IOS13•
81B, STEAMIER, PROOFER,
(:ARBONA'1'OR, SWAMI' COOI.I(RS
54
=
818
(:1tOS.S CONNECTION DEVICES
VACUUM BREAKER, (:I IECK \'RINE,
ANI) R.P.B.P.D. FOR : VA'I S, SUMIPS,
TANKS, BOILERS, & SPRINKLER
SYSI'EMIS
56
=
BI9
IN'IVRCIWI'ORS
GREASE TRAP, SAND TRAP,
CI IIEMIC.•I. HOLDING TANK
s
54
=
1320
MEDICAL GAS (per outlet/bottle station)
NITROUS, OXYGEN
x
56
=
821
MISCEI.I.:INEOUS FIXTURES
56
=
METHOD OF PAYMENT
SUWIXY[\.
PLUS PROCESSING ENE
S 25.10
VISA1
❑ C.\SII 0 CIII(CK 0 !moi 0 '?r,' 0
P \SI.D PINI\III$ Will. U\IS 11E .\CCIi1'llD \\'1'1111' \\'\MPSI
OF.\ NI VOR CIU.Drr cut')
D \'1'1:: EXPIRES:
NiCOVER
_
,:..:7 -
'I'U'I'.\I. PERMIT FEN DUE
MINIMUM PERMITFEE IS$3500
PLEASE:: I\L\KE C1 IECKS PAY.\B1J: 1'0
SPOK.\NIC COUNTY PERMIT (:EN'17(1t
8 \NK(:.\RD NUMIBICIR:
.\UTI IOltIZ.RD SIGNATURE.
Spokane County Division of Budding & Code I•:nforerment
1026 West Broadway Avenue ' Spokane, W. 992411-0)51)
Telephone No. (5119) 477-3675" Fax No. 477-7198 TDD No. (509) 477-713.3