1996, 06-24 Permit App 96004769 SewerSEWER CONNECTION PERMIT
o APPLICATION FORM
PLE IOTE: t his 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 from the date of issuance. No
extensions will be granted.
Job address:
i l 7l7 l-23 ��
City: , ��_,47.i✓u
Zip: .2/12 .
Parcel number(ifkttowtt):
PROJECT INFORMATION
Dry Line
Sewer? (Y/N)
Owner's name:
cy°
City/State: Ste
Zip: 9' QO
Phone:
First-time contractors or home -owners performing the installation must first contact the utilities department (in person
or via phone [456-3604J) before a permit can be issued.
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Contractor (company name):
H 4 S CnoSii t11 L-}—lt"�l1
Business address:
1 11-) VK1,t i n a{ v✓� �
City/State: hS ,GSA c 1A�
Zip: C{ o? Phone: q 2 .((, — e
State contractor license number:
E-j 5 Gr7 K1 * 12 3 -K
Utilities installers permit number:
INTERIOR PLUMBING ALTERATIONS? (yes/no) circle.
Fill out the information in the table below if applicable**
Contractor (if different from above): Phone: i 2,/ - a n 5 8
Business Address: Cit
1 P`4h
ate/Zip:
re Acxc rr 5 WA cl q,o
6h 1`
S N ".! I ^II"Ilcgj�;ec' sd!'i;lu^!';;•y � ,I..,.,�,;'e !:i'Ia "Y lil 'a'„'TI' 4. p .,,,u jii �I:I � `vira ri��g ' n Y'e'! r '��N"�tl'r�ll' 'i lglnwn•%L'Ilia, � I (rj:a� 71 ii
11�V FI 4 d I,'I „rgiJl G�6�II,h.VflI r�hllNISI �" Illll lfl 7JrI�I II tl r� :.hIfNlll k9dNl, �V� Eh�.^i,l.l�r,IUIrlir Il CIG16IiI 1 ;11111il
1.I�v�mi?il �}Lh"hYl�4111'a:l ljO�1t17lllligkfil: reVerl! is l af/z40'l7/ia^�JOIlgWSe Nlii!N4! I pI � �II�jiI7SfOr ti����p1.1i
I
FEE INFORMATION
Sewer Connection: Number of Buildings v X (times) $50 (per bldg) = $
TOTAL FEE
* One permit required for each separate building, shop, garage, etc., that will be connected to the sewer.
* Condos, townhouses, & 2- 3- and 4 plexes require 1 permit per address/stub.
* Multiple buildings (apartments, industrial complexes) require 1 permit per building.
(For situations not covered here, call the County Utilities Division @ 456-3604)
APPLICANT SIGNATURE: , ✓ ,�i i�� 1 Date: f2,7A
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260
PHONE: (509) 456-3675 * FAX: (509) 324-3198 * TDD: (509) 324-3166
Spokane County does not discriminate on the basis of disability In the admission to, or treatment or employment in, its programs or activities.
tasks c\winwaau.w.p(t
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER:
PHONE: DAYTIME CONTACT
MAILING ADDRESS:
(street)
C°NTRACMR: ob? r4- 01nhAsr)n --PuArA k
MAILING ADDRESS: I rl S 20 a (0-frin
(street)
(city/state)
(zip)
LICENSE:4 g e_72, %9Q:p c5 81
PHONE:
tire' cnarrrs WA cietiNk
(city/state) (rip)
.00
TOILETS
PLUMBINGI•IXTU'RES
DESCRIPTION DETAIL
WATER CLOSETS BIDETS
# OF
UNTTS
KEW WY
x
COST
/UNTT
$6
SOUALS
AMOUNT
$
•
st)3.
URINALS
x
$6
$
B04
TUBS
BATH. JACUZZI. SPA. GARDEN
x
$6
$
.tog
SHOWERS (per trap)
SINKS
DISHWASHER'
RASP STALL, ON—S(TE BUM
LAYS/BASINBAR,FLOOR,KITCHEN,
LAUNDRY. =Irv, JANITOR, PHOTO,
X—RAY.FOOD (PREP/CULINARY/MEAT)
x
x
$6
$6
$6
$
$
B08
B09
CLOTHES WASHER
GARBAGE DISPOSAL/GRINDER
x
$6
$6
$
$
BLO
1111
BI4
WATER SOFTENER
ELECTRIC HOT WATER TANKS
FLOOR DRAINS
ROOF DRAINS/OVERFLOW DRAINS (ea.)
FOUNTAINS, DRINKING
(NOTE if gas water tank, gee raeahaniad)
AREA, CP COLL, TRENCH, CONDENSATE
x
x
x
x
x
' $6
$6
$6
$6
$6
$
$
$
$
$
815
c816
altta
WATER PIPING/DRAIN—WASTE—VENT/
PLUMBING REVERSALS
SEWAGE EJECTORS
INSTALLATIOH ALTERATION, REPAIR.
REvERcAT
GRINDER, SUMP PUMP
x
$6
$6
$
$
S.
aLlSi8
WATER USING DEVICES
ICE AND/OR COFFEE MAIZER,
HOSE BIB STEAMER, PROOFER,
CARBONAIDR. SWAMP COOLERS
x
$6
$
BIS CROSS —CONNECTION DEVICES
...,...
.,..,...
VACUUMBREAKER. CHECK VALVE
AND R.P.B,PD. FOR VATS, SUMPS,
TANK& HOMERS. & SPRINKLER SYSTEMS
x
$6
$
B1.9 INTERCEPTORS
1$2:0
)321
GREASE TRAP, SANDTRAP,
CHEMICAL HOLDINGTANK
x
$6
$
MEDICAL GAS (per outlet/bottle station)
MISCELLANEOUS FIXTURES
NITROUS, OXYGEN
x
x
S6
$6
$
NO It: MINIMT_JM PERMIT FEE IS S35.00
SIGNATURE:
ipokane County Division of Buildings
L026 W. Broadway Avenue Spokane, WA 99260
fel. No. (509) 456-3675 " Fax No. (509) 324-3198 • TDD No. (509) 324-3166
Spokane County does not discriminate on the basis of disability in the admission to. or treatment or employment in. its programs or activities.
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
$
*EreASZ:MAKM.CITECICSPAZAA3rn:SC)
SR:t0ICAZW:!.:COUNTZERERVIITICENTIVit
SEWER TRANSMITTAL�' 5p, tpl(o -D5
e.
11-(Z,3
MA4"js Ff (Ti.,' J
t4.
2311
W I I.13l_SIZ ( P f3 `�
% - 63g
LOCATION 4,),
Z3ZS
WlL,6L)r,.(rAr-CCrL A `)
639.
❑ 1 load pennlis
Issue peiinlls
1=1 Con(1111ons
COMMENTS d1Z5 1 Jc aobD
• Investigation fee
❑ Re -inspection fee
❑ 011ier
By f)I LLL-,w-� , Dale G• 25 �i�.
—j
J �Mf
ITS AlZG FoZ P-)DBlC r-f2i" MAtirJ '7�2 19&FffalY LAiL
cw Y 51.)6553Q0� CcW)A1k5LZi&J5 tb MA")UW4e722J&V Mb;165
CA -I\) -AJO7 f,')g- Mj,AVS OtjTiG S4�X CC91/nJciL14EW �969&Z-9Lj0\cC4
A126 S16A[ ) A-AJrJ CO;AJAJ&T--(cad tW Ai&ff P9,4%0,
Loc.��ibrl - f�T.�OlzesS
5�.13U�v iS� v n1
" 02
lAL-\O
DATE:
TO:
RE:
NOTICE OF TRANSMITTAL
/- as -On
Uadi
11123 6 tManscad
FROM: Stacey
NUMBER OF PAG (excluding cover)
ATTACHED FIND:
SHOP DRAWINGS:
SPECIFICATIONS:
REASON FOR TRANSMITTAL:
YOUR APPROVAL
CORRECTIONS NEEDED
OTHER
REMARKS:
11111111111
SPOKANE COUNTY
0/68-445q-2 3
rgialevinaffetti
OTHER:
YOUR USEIINFORMATION
APPROVED AS NOTED
REVIEW & COMMENT
[CR YOUR REQUEST
PUBLIC WORKS DEPARTMENT
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE - SPOKANE, WASHINGTON 99260
PHONE: (509) 477-3675
ADMINISTRATION FAX: (509) 477-4703
PERMIT CENTER FAX: (509) 477-7198
PROJECT NUMBER= 96004769 APPLICATION DATE= 06/24/96 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 11723 E MANSFIELD AVE PARCEL#= 45094.0513
ADDRESS= SPOKANE WA 99206
PERMIT USE= SEWER CONNECTION - DCA (96S-637)
PLAT#= 005713 PLAT NAME= SP-1016-95
BLOCK= LOT= 4 ZONE= UR-3.5 DIST#= H
AREA= 00000000 F/A= F WIDTH= 1010 DEPTH= 195 R/W= 50
# OF BLDGS= # DWELLINGS= WATER DIST = IRVIN
OWNER= NUEHS, KEN
STREET= 11715 E MANSFIELD AVE
ADDRESS= SPOKANE WA 99206
PHONE= 509 327 7243
CONTACT NAME= LEONARD - H & S PHONE NUMBER= 509 926 8964
BUILDING SETBACKS: FRONT= NA LEFT= NA RIGHT= NA REAR= NA
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
UTILITIES CONNECTION AGREEMENT REQUIRED
COMMENTS:
516,
***************************** SEWER PERMIT ******************************
CONTRACTOR= H & S CONSTRUCTION
STREET= 11817 E VALLEYWAY AVE
ADDRESS= SPOKANE WA 99206
ITEM DESCRIPTION
PROCESSING FEE
PHONE= 509 926 8964
QUANTITY FEE AMOUNT
Y 10.00
SEWER CONNECTION 1 40.00
PERMIT TYPE
FEE AMOUNT AMOUNT PAID AMOUNT OWING
SEWER PERMIT 50.00 .00 50.00
50.00
PROCESSED BY: JULIE SHATTO
PRINTED BY: JULIE SHATTO
.00 50.00
******************************** THANK YOU ************************************