2005, 12-27 Permit App: 05004771 Sewer ReversalSp`.k
Walley
Community Development
Plumbing Permit Application D Commercial
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.sookanevallev.orz.com
PERMIT NUMBER: G\S---r7
PERMIT FEE: TI
esidential
SITE ADDRESS: .moi . -$J�z�
Building owner_
Name: .17�!
Address:
Contractor
Name:
Phone:
City:
Phone:
State:
Fax:
Fax:
Zip:
Address:
City :
State:
Zip:
License No:
City Business License No:
Contact
Name:
Phone:
AUTHORIZED SIGNATURE:
REVISED 5/26/05
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
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL TRENCH, CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
=
/
4 C
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
=
16
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
Card#
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
y / O 6
AUTHORIZED SIGNATURE:
REVISED 5/26/05
SPOKANE C LN IY
SPOKANE COUNTY
DEPARTMENTOr BUILDING & PLANNING
1026 WEST BROADWAY AVENUE • SPOKANE, WA 99260-0050
Site Information
Project Information
Site Address: 923 S MARIAM ST
Parcel Number: 45203.1304
Subdivision: SHERWOOD FOREST
Block: Lot:
Zoning: SFR
Owner: WOOD, SAM
Address: 923 S MARIAM ST
SPOKANE, WA 99206
Building Inspector: NONE
Water Dist:
Project Number: 05009566 Inv: 1 Issue Date: 12/23/2005
Permit Use: SEWER CONNECTION - SHERWOOD FOREST/MICA
PARK
Applicant: COURCHAINE CONSTRUCTION
19818 E SPRAGUE
GREENACRES, WA 99016 Phone: (509) 924-5485
Contact: COURCHAINE CONSTRUCTION
19818 E SPRAGUE
GREENACRES, WA 99016 Phone: (509) 924-5485
Setbacks - Front: Left: Right: Rear:
Group Name:
Project Name:
IPermits I
Sewer Connection Permit
Contractor: COURCHAINE CONSTRUCTION License #: COURCC*181 R7
SEWER CONNECTION 1 $85.00 PROCESSING FEE
Total Permit Fee:
FOR SEWER INSPECTIONS CALL (509) 477-3604 UTILITIES 8:30-5:00 PM MONDAY THRU FRIDAY
$15.00
$100.00
Call for inspection prior to cover. ONE WORKING DAY NOTICE REQUIRED.
Contractor or applicant is to field locate and confirm the elevation and position of sewer stub prior to any other excavation.
Sewer stubs are to be checked prior to connection to ensure that they have acceptable grade and are clear and unobstructed to the main
sewer. Sewer lines should be constructed to allow for gravity flow from the lowest level of the structure.
This permit must be presented to the job site inspector for verification. To locate buried cables, gas piping, water lines, etc.
CALL BEFORE YOU DIG, (509)456-8000.
STATE LAW RCW 19.122 REQUIRES THAT PRIOR TO ANY EXCAVATION THE "CALL BEFORE YOU DIG" CENTER BE
NOTIFIED. CALL BEFORE YOU DIG AT LEAST 2 WORKING DAYS IN ADVANCE, (509)456-8000.
Spokane County Code requires the installer comply with all requirements of the Washington State Dept of Labor and Industries,
including those related to trench safety.
i
Payment Summary
Total Fees AmountPaid AmountOwing
$100.00 $100.00 $0.00
Tran Date Receipt # Payment Amt
12/23/2005 7814 $100.00
Processed By: DOMPIER, DAWN
Printed By: HINTZ, FAITH Page 1 of 1
PERMIT