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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 ************************************