2005, 02-10 Permit App: 05000421 Plumbing Fixtures 02/24/05 07:57 TY509 324 3603 SF0 REGIONAL HEA g OO2
• FEB 10 2005 10:17 FR TO 3241567 P.02/03
?rojactNumber: 05000121 Inv: 1 Application Date: 02/10/2005 rage 1 of 2
nits IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
' ect IrtformatiotL a.......__
.Fe t±Use: TOILET,4-SINKS,CLTHSWSHR&ELEC BOT Contact: NELSON,LON&LORETTA
WTR TANK FOR SHOP BUILDING Address: 13924 E 12TH AVE
. C-S-Z: SPOKANE VALLEY,WA 99037
Setacks:Front Left: Right: Rear: Phone: (509)927-2415
Group Name;
i e Information:
Project Nara:
Plat Key: 002751 Name: VERA District: Soot
Parcel Number-45233.1909 Block: Lot - -_
SiteAddress: 13924 E.12TH AVE Owner:Name: NELSON,LON&LORETTA
Address: 13924 E 12TH AVE
Location::CSV SPOKANE VALLEY,WA 99037
Zoning:AGRI
Water District: Hold:
Arca: .00 Acres Width: 112 Depth: 200 Right Of Way(ft): 0
Nbr of Bldgs: 4 Nbr of Dwellings: 1
Review Information: wipps= ASSIXOlgeteadtZ240=
Review
Special Review
Fannits: .
Plumbing Permit ... --
Contractor: OWNER Firm OWNER
Phone: (000)000-0000
Iter Deserioti___na Units Unit Desc Fe Amount
TOILETS/BIDETS 1 NUMBER OF $6.00 0
SINKS 4 NUMBER OF $24.00
CLOTHES WASHER 1 NUMBER OF $6.00
:!:'.L'ECT'`:HOT WATER TANK 1 NUMBER OF 56.00
PROCESSING PEE I SELECT $35.00
Permit Total Ftes: $77.00
(3pertt ut 'K C Printed By: K C Prins Date: 02/10/2005
FEB 24 2005 08:17 509 324 3603 PAGE.02
r
Project Number: 05000421 Inv: 1 Application Date: 02/10/2005 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: TOILET,4-SINKS,CLTHSWSHR&ELEC HOT Contact: NELSON,LON&LORETTA
WTR TANK FOR SHOP BUILDING Address: 13924 E 12TH AVE
C-S-Z: SPOKANE VALLEY,WA 99037
Setbacks:Front Left: Right: Rear: Phone: (509)927-2418
Group Name:
Site Information Project Name:
Plat Key: 002751 Name: VERA District: Sout
Parcel Number: 45233.1909 Block: Lot:
SiteAddress: 13924 E 12TH AVE Owner:Name: NELSON,LON&LORETTA
Address: 13924 E 12TH AVE
Location::CSV SPOKANE VALLEY,WA 99037
Zoning: AGRI
Water District: Hold: ❑
Area: .00 Acres Width: 112 Depth: 200 Right Of Way(ft): 0
Nbr of Bldgs: 4 Nbr of Dwellings: 1
Review In formation: m a,k
Review
Special Review l7�/JL4 G' Released By: j
/
Plumbing Permit
Contractor: OWNER Firm: OWNER
Phone: (000)000-0000
Item Description Units Unit Desc Fee Amount
TOILETS/BIDETS 1 NUMBER OF $6.00
SINKS 4 NUMBER OF $24.00
CLOTHES WASHER 1 NUMBER OF $6.00
ELECTRIC HOT WATER TANK 1 NUMBER OF $6.00
PROCESSING FEE 1 SELECT $35.00
Permit Total Fees: $77.00
Operator: K_C Printed By: K_C Print Date: 02/10/2005
Project Number: 05000421 Inv: 1 Application Date: 02/10/2005 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes: R: .4 1 .,H:s .. w; MEW..
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Plumbing Permit $77.00 $77.00 $0.00 $77.00
$77.00 $77.00 $0.00 $77.00
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: K_C Printed By: K_C Print Date: 02/10/2005
PLUMBING PERMIT APPLICATION Community Development Department
iirII Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
Vary For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
go/
or:L-04
Project Address: 1 3 •a `Q /a t'K Permit Use:
14.0me 427-2411-
Owner: Lv rt) ('' N . lS'a rt-) Phone (Daytime Contact): to c_( 4c N at°L
Mailing Address: /4 9 l S r 1-7 tIK. C4 SPekY v Witter CU )3, (31,q 6 3 7
City State Zip Code
Contractor: License#: Phone#:
Mailing Address:
City State Zip Code
DESCRIPTION OF WORK *OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS / X $6.00 =
2 URINALS X $6.00 =
3 TUBS X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 =
• LAVS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, 44 X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT
•
6 DISHWASHER / X $6.00 =
7 CLOTHES WASHER X $6.00 =
8 GARBAGE DISPOSAL X $6.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL / X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6.00 =
ROOF DRAINS/OVERFLOW
12 DRAINS X $6.00 = ,
13 FOUNTAINS,DRINKING X $6.00 =
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR,
14 VENT,PLUMBING,REVERSAL REVERSALS X $6.00 =
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X , $6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB,
16 WATER USING DEVICE STEAMER X $6.00 =
PROOFER,CARBONATOR,SWAMP COOLER
VACUUM BREAKER,CHECK VALVE,
17 CROSS CONNECTION DEVICE AND R.P.B.P.D.FOR: VATS,TANKS,BOILERS X , $6.00 =
GREASE TRAP,SAND TRAP,
18 INTERCEPTORS CHEMICAL HOLDING TANK X $6.00 =
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN _ X $6.00 =
MISCELLANEOUS PLUMBING
20 FIXTURE X $6.00 =
21 PRIVATE SEWAGE DISPOSALJSYS , X $20.00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
❑ CASH ❑ CHECK 0 VISA 0 MASTERCARD $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
.4105 07:57 $509 324 3603 SPO REGIONAL HEA X1001
SPOKANE • REGIONAL Environmental Health
HITH 1101 West Spokane,WA Co119920 e Avenue, Room 402
DISTRICT Phone 509-324-1560
FAX 509-324-3603 or 324-1567
Fax
To: Kathy Cummings From: Eric Meyer
Fax 688-0037 Phone: 324-1582
Phone: 688-0175 Date: 02/24/2005
Re: Project 05000421 Pages including coven 2
D Urgent ❑ For Review ❑ Please Comment ❑Please Reply ❑ Please Recycle
Comments:
Hello Kathy,
We are ok for permit issuance on this project. No changes to the septic system are being required at this time. Call
if you have questions.
Thanks-
Eric
C lit (' (
FEB 24 2005 06: 17 509 324 3603 PAGE.01
SPOKANE • REGIONAL
H LT H
DISTRICT
1101 West College Avenue
Spokane,WA 99201-2095
509.324.1500 I TEL
509.324.1464 TDD
www.SRHD.org
February 24, 2005
Mr. Lon W. Nelson
14915 E. 17th Court
Veradale, WA 99037
RE: Lonnie Bills Tropical Sno, Located at 13924 E. 12th Avenue., Spokane Valley, WA
Dear Mr. Nelson:
As required under Section 1.05.145 of the Spokane Regional Health District Rules and
Regulations for Food Service Establishments, this agency has reviewed the food menu, the food
preparation sheet, and the building construction plans for the above-referenced project. We have
found the plans to be complete and are issuing our approval. We will be notifying the appropriate
building department of our approval in order for you to obtain your building permits and
commence construction.
A fee of $65.00 per hour is charged for the plan review and pre-occupancy inspection. An
invoice will be given to the person in-charge at the time of the pre-occupancy inspection. The
fee is to be paid within 30 days of receipt of invoice. A $65.00 late fee will be applicable if not
paid within the 30 days.
After you have completed construction, the Health District will conduct a pre-opening
inspection. At the time of this inspection it will be verified that the construction is in compliance
with the approved plans. (Any changes in menu or equipment shall be pre-approved by the
Health District prior to construction.) Any equipment installed in the establishment is to be NSF
approved or equivalent. Any home-style equipment found on the premises will have to be
removed.
The permit to operate will be given to you at the end of the pre-opening inspection if the
construction is found acceptable and all the other appropriate agencies have given their approval.
To insure that you obtain your pre-opening inspection in a timely manner we request that
you contact us at least three (3) days before you want an inspection to arrange it in our
schedule.
All employees handling unwrapped food are to obtain a food worker card within 14 days of
employment. Enclosed is a handout listing class schedules.
Mr. Lon W. Nelson
February 24, 2005
Page 2
Thank you for the opportunity to review your project. If you have any questions, please feel free
to contact me at 324-1560 ext. 2.
Sincerely,
ENVIRONMENTAL HEALTH DIVISION
te-c .- R-s,
Janet Wheeler, R.S.
Environmental Health Specialist
Encl.
c: City of Spokane Valley Bldg. Dept.
JW/lh