2011, 10-18 Permit 11003218 RefundSpa'oliane
11703 E Sprague Ave Suite B-3 • Spokane Valley WA 99206
♦509.720.5240 ♦ Fax: 509.688.0037 •
Memorandum
Date: 10/18/2011
To: FINANCE DEPARTMENT
From: JENNA DAVIS
CC: MARY KATE MCGEE
Re: REFUND - 2216 N COLEMAN - ROW / PLUMBING PERMIT - ROW - SEWER W/ 1
BLDG DRN CONN
PROJECT NUMBER: 11003218
PROJECT ADDRESS: 2216 N COLEMAN RD
PROJECT TYPE: ROW/PLUMBING PERMIT
REASON: Refunding processing fee amount of $37 as it was charged in
error.
REFUND TYPE: Per the currently adopted fee schedule, please refund the
applicant's visa in the amount of $37.
GL ACCOUNT : \! (O3 ` COI C✓S C C j 32a 00?
AUTHORIZED BY: y1rLg . V-a4-c
DATE: 2,3(/
ORIGINAL TO FINANCE AND COPY TO FILE WITH PAPERWORK
Spokane
Valley®
Permit Center
11703 E Sprague Ave Suite B3 Spokane Valley WA 99206
509.720-5240 4. Fax: 509.688.0037 ® email: permitcenter@spokaneyalley.org
Site Information
Project Information
Site Address: 2216 N COLEMAN RD
Parcel Number: 35124.0606
Subdivision:
Block: Lot:
Zoning: R-2 SF Res Suburban District
Owner: KINGSLEY, VALERA
Address: 2216 N COLEMAN RD
SPOKANE, WA 99212-1469
Building Inspector: NORTH
Water Dist: ORCHARD AVENUE
Project Number: 11003218 Inv: 1 Issue Date:
Permit Use: BUILDING DRAIN CONNECTION
10/11/2011
Applicant: NORMS Excavating
PO BOX 574
VERADALE, WA 99037 Phone: (509) 928-0580
Contact: NORM'S Excavating
PO BOX 574
VERADALE, WA 99037 Phone: (509) 928-0580
Setbacks - Front: Left: Right: Rear:
Group Name:
Project Name:
Permits
Plumbing Permit
Contractor: NORM'S EXCAVATING INC License N: NORMSEI972BM
PROCESSING FEE
FOR PLUMBING INSPECTIONS CALL (509) 688-0054.
$37.00 BUILDING DRAIN CONNECT' 1 $6.00
Total Permit Fee: $43.00
Right of Wav
Contractor: NORMS EXCAVATING INC License #: NORMSEI972BM
ROW- NO CUT OBS CLEANUP 1 $110.00
Total Permit Fee: SI10.00
FOR RIGHT OF WAY INSPECTIONS CALL
(509) 869-5373 ENGINEERING
Payment Summary
Total Fees AmountPaid AmountOwing
$153.00 $153.00 $0.00
Tran Date Receipt # Payment Amt
10/11/2011 28670 $153.00
Processed By: BONDURANT, MICK
Printed By: MORRIS, HEATHER Page 1 of 1
PERMIT
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Permit Center
rSikikane 11707 E Sprague Ave, Suite 106
Slley Spokane Valley, WA 99206
®" (509)688-0036 FAX: (509)688-0037
Community Development wnnv.snokancval ley nr„com
Mail or Fax To: �/n{, Opi
Norms Excavating, Inc. LL o0 V N
PO Box 574
Veradale, WA 99037
Fax 892-0432
PERMIT ;NUMB
1 P 3 'a
PERMITFEE: (ee
�y
Plumbing Permit Application (1 Commercial ® Residential
SITE ADDRESS: 2216 N Coleman 35) i • 0406
Building owner
Name: Kingsley
Phone. 92 [-2792
Fax:
Address: SAME
City. State:
Zip:
Contractor
Name: Norm's Excavating, Inc
Phone: 509/928-0580
Fax: 509/892-0432
Address: PO Box 574
City : Veradaie State: WA
Zip: 99037
License No: NORMSEI972BM
City Business License No:
Contact
Name: Sheila Gibbons
Phone: 928-0580
D
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
=
5
SINKS
LAVS/BASINS, BAR. FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD. PREP/CULINARY MEAT
X
$6.00
=
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
56.00
=
11
FLOOR DRAINS
AREA. CASE, COIL, TRENCH. CONDENSATE
X
$6.00
12
ROOF DRAINS/OVERFLOW
DRAINS
X
S6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
14
WATER PIPING/ORAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
S6.00
=
6.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P,B.P.D. FOR VATS, TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASETRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS. OXYGEN
X
S6.00
—
—
20
MISCELIANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOCA: /SYS
X
$20.00
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
—
METHOD OF PAYMENT:
❑ CASH 0 CHECK
Card# See Cover Sheet
SUBTOTAL
6,00
® VISA 0 MASTERCARD
PROCESSING FEE
EXPIRES:
TOTAL PERMIT FEE DUE:
6.00
AUTHORIZED SIGNATURE:
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ShoThane
Valley
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Call 24 hours before inspection requires
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date 10-24-2011 Permit # Account # 000122
ROW CONSTRUCTION PERMIT
Location of property 2216 N Coleman
(Address/Parcel #, if available)
Applicant Name Kingsley
Address Same Fax 892-0432
Contractor's Name Norm's Excavating, Inc.
Address PO Box 574 Veradale, WA 99037 Phone 509/928-0580
Contractor's Reg# NORMSEI972BM Expires 01/14/13
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Sewer Connection Driveway
Curb & Gutter I J Gas Installation/Repair
Cable/Conduit/Pole
Other
x
11
Pavement Cut
Sidewalk Repair/Construction
Dimensions
Bond/insurance certification must be on file with the City. Bond # 103957298
Permittee Signature Approved
Date
t hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # See Cover Sheet
Name of Holder
Expiration Date
Signature
Fees Paid$ 110.00
(Application) (Inspection)
In addition to the permit application fee of $16.00 (utility) or $25.00 (construction), inspection on
each permit will be billed to the permittee at a rate of $50.00 per hour with a $25.00 (1/2 hour)
minimum. Pennittee signature constitutes an agreement to these terms and provisions.
Date Init
Work completed satisfactorily (Signed)
Permit not valid until One -Call Notification Ticket # entered here
Date
PERMTT MUST BE KEPT ON SITE