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2003, 10-22 Permit App: BLD-03-02859 Plumbing=OD OF CASH kTE: aTY or 0� vu-nne ,,;00*Va.11ey 11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone Spokane Valley, SNA 99206 509-688-0037 - Fax For Inspections, call 509-688-0054 Plumbing Permit Application PROJECT ADDRESS: 15 f3 y<:Z ml PERMIT USE: OWNER: X PHONE (Daytime Contact): MAILING ADDRESSS: � �/-3 sV/ AMOUNT 1 (street) (city/state) (ZIP) CONTRACTOR LICENSE #: MAILING ADDRESS: _ 2 PHONE #: e"26C (street) je (city/state).. (ZIP) PLUMBING FIXTURES LNKCARD NUMBER: JTHORIZED SIGNATURE: FXPIRES: DESCRIPTION DETAILS # OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET, BIDETS X $6 - 2 URINALS X $6 - 3 TUBS X $6 - 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT X $6 5 SINKS LAVSBASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X- RAY, FOOD, PREP/CULINARY/MEAT X $6 - 6 DISHWASHER X $6 - 7 CLOTHES WASHER X $6 - 8 GARBAGE DISPOSAL X $6 - 9 WATER SOFTENER X $6 - 10 ELECF. HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL X $6 - 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6 - 12 FOUNTAINS, DRINKING X $6 - 13 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING. REVERSAL INSTALLATION, ALTERATION, REPAIR, REVERSALS / X $6 - 14 SEWAGE EJECTOR GRINDER, SUMP PUMP X $6 - 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLER X $6 - 16 CROSS CONNECITON DEVICE VACUUM BREAKER, CHECK VALVE, AND RP.B.P.D. FOR: VATS, TANKS, BOILERS X $6 17 SPRINKLER SYSTEM X $25 - 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X - 19 MEDICAL GAS per outlet NITROUS, OXYGEN X $6 - 20 IMISC. PLUMBING FIXTURE X $6 - PAYMENT ❑ CHECK ❑ ❑ �. _.. SUBTOTAL: PLUS PROCESSING FEE: $35.00 TOTAL PERMIT FEE DUE: / Ob LNKCARD NUMBER: JTHORIZED SIGNATURE: FXPIRES: SPOKane ,,r,,, O Valley 11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone Spokane Valley, WA 199206 509-688-0037 - Fax For Inspections, call 509-688-0054 -Mechanical Permit Application PROJECT' ADDRESS: OOFUNITS X PERMIT 1 FUEL BURNING APPLIANCE - OR < 100,000 X USE: OWNER > 100,000 X PHONE (Daytime Contact): MAILING ADDRESS: - OR < 400,000 X S 3 IV, 4 UNLISTED APPLIANCE (ADDITIONAL FEE) > 400,000 X $100 - 5 USED APPLIANCE (WSEC min. AFUE rating) (street)±/(dj0F/nsta(ZIP) X $50 - CONTRACTOR: > 400,000 X #: MAILING ADDRESS:© 1-100M BTU X $15 8 BOILER/REFRIGERATION 101- 500M BTU (street)city/state $28 - (ZEP) METHOD OF PAY) DESCRIPTION OF WORK OOFUNITS X COST EQUALS AMO[INT 1 FUEL BURNING APPLIANCE - OR < 100,000 X $15 2 FUEL BURNING APPLIANCE > 100,000 X $19 - 3 UNLISTED APPLIANCE (ADDMONAL FEE) - OR < 400,000 X S50 4 UNLISTED APPLIANCE (ADDITIONAL FEE) > 400,000 X $100 - 5 USED APPLIANCE (WSEC min. AFUE rating) - or <400,000 X $50 - 6 USED APPLIANCE (WSEC min. AFUE rating) > 400,000 X $100 7 BOILER/REFRIGERATION 1-100M BTU X $15 8 BOILER/REFRIGERATION 101- 500M BTU X $28 - 9 BOILER/REFRIGERATION 501-1,000M BTU X $39 - 10 BOILER/REFRIGERATION 1001-1,750M BTU X $57 - 11 BOILER/REFRIGERA -ON +1750M BTU X $95 - 12 GAS LOG, GAS INSERT, GAS FIREPLACE - X $10 13 RANGE - X $10 - 14 DRYER - X $10 - 15 FUEL BURNING WATER HEATER - X $10 16 MISC. FUEL BURNING APPL. - X $10 - 17 GAS PIPING (ea. Outlet) - X $1 - 18 DUCT SYSTEMS _ X $10 - 19 VENTILATING FANS - X $10 - 20 AIR HANDLER (DOES NOT include ducting) - OR < 10,000CFM X $12 - 21 AIR HANDLER (DOES NOT include ducting) > 10,000 CFM X $19 = 22 EVAPORATIVE COOLERS - X $10 - 23 TYPE I HOOD _ X $50 - 24 TYPE II HOOD - X $10 - 25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12 - 26 AIR CONDITIONER 3-15 TON X $20 = 27 AIR CONDITIONER 15-30 TON X $25 - 28 AIR CONDITIONER 30-50 TON X $35 - 29 AIR CONDITIONER +50 TON X $60 - 30 LPG STORAGE TANK - X $10 - 31 WOOD OR PELLET STOVE/INSERT - X $10 32 WOOD STOVE - FREE STANDING - X $25 KENT c —- SUBTOTAL: PLUS PROCESSING FEE: $35.00 TOTAL PERMIT FEE DUE: ❑ CASH ❑ CHECK DATE: BANKCARD NUMBEIL- AUTHORIZEiD SIGNATURE: ❑ ❑ EXPIRES: Site Information Project Information Site Address: 1513 N SARGENT RD SPOKANE, WA 99212 Parcel Number: 45181.0502 Subdivision: HUTCHINSONS ADD Block: Lot: Zoning: UNK Unknown Owner: FALCON Address: 1513 N SARGENT RD SPOKANE, WA 99212 Building Inspector: BOBBY STONE Water Dist: Plumbin,Q Permit Contractor: BELKNAP PLUMBING WATER PIPING - D W V MINIMUM FEE ADJUSTMET FOR PLUMBING INSPECTIONS CALL (509) 477-3675. Sewer Connection Permit ': COURCHAINE CO Project Number: 03007653 Inv: 1 Issue Date: 10/22/2003 Permit Use: SEWER CONNECTION AND PLUMBING REVERSAL Applicant: COURCHAINE CONSTRUCTION 19818 E SPRAGUE GREENACRES, WA 99016 Contact: COURCHAINE CONSTRUCTION 19818 E SPRAGUE GREENACRES, WA 99016 Setbacks - Front: Left: Right: Group Name: Project Name: License #: BELKNP*071D6 1 $6.00 PROCESSINGFEE $4.00 Phone: (509) 924-5485 Phone: (509) 924-5485 Rear: Total Permit Fee: License #: COURCC*181R7 SEWER CONNECTION 1 $85.00 PROCESSINGFEE $15.00 $25.00 $35.00 Total Pennit Fee: $100.00 FOR SEWER INSPECTIONS CALL (509) 47/-3604'U TILITIES 8:30-5:00 PM I1+IONDAY THRU FRIDAY Call for inspection prior to cover. ONE WO RKiI�G•�A.�'' NOTICE REQUIRED: a Contractor or applicant is to field locate and confirm the elevation and position of sewer siuli 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 flew from thelowest levef'of the structure. This permit must be presented to the job site inspector for verification.. ,To locat 'buried cable`s, 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. Processed By: FORRY, JEFF PERMIT Printed By: WENDEL, GLORIA Page 1 of 2 Project Receipt Summary Wednesday, November 12, 2003 Page IofI Address 1513 N SARGENT RD PROJECT#: 03007653 Owners Name: FALCON Phone: (509) 000-0000 Address: 1513 N SARGENT RD SPOKANE, WA 99212 Occupant: Phone: Applicant: COURCHAINE CONSTRUCTION Phone: (509) 924-5485 Use: SEWER CONNECTION AND PLUMBING REVERSAL"11/12/03 Canceled Application Date: 10/22/2003 Permit Issue Date: 10/22/2003 Receipt Nbr: 6744 Transaction Date/rime: 10/22/2003 9:35:17 AM Acct Account Transaction I Description Total Due Amount Paid 01001 UTILITIES DEPT P $85.00 $85.00 01000 RESIDENTIAL PMTS P $15.00 $15.00 00610 PLUMBING PMTS P $35.00 $35.00 $135.00 __ $135.00 Tender Type Cash Receipt Nbr: 7249 Amount Paid Payer $140.00 Transaction Date/Time: 11/12/2003 2:58:10 PM Acct Account Transaction Description Total Due Amount Paid 00610 PLUMBING PMTS R $0.00 ($35.00) $0.00 ($35.00) Tender Type Amount Paid Payer Checkl ($35.00) AMOUNT REFUNDED FOR THE PLUMBING PORTION OF PERMIT. JURISIDICTION LOCATED IN THE CITY OF SPOKANE VALLEY. REFUNED W/ VOUCHER # 211703. PAP Site Information Site Address: 1513 N SARGENT RD SPOKANE, WA 99212 Parcel Number: 45181.0502 Subdivision: HUTLHNSONSADD Block: Lot: Zoning: UNK Unknown Owner: FALCON Address: 1513 N SARGENT RD SPOKANE, WA 99212 Building Inspector: BOBBY STONE Water Dist: m!� ,I-ISION OF : BU3ILDING 'DE E1 CSG MENT r OAS ,''1`�96b-O�U50 Pr'dject Information Project Number: 03007653 Inv: 1 Issue Date: 10/22/2003 Permit Use: SEWER CONNECTION AND PLUMBING REVERSAL 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: Permits Plumbing -Perm Contractor: BELKNAP PLUMBING License #: BELKNP•071D6 WATER PIPING - DWV 1 $6.00 PROCESSING FEE $25.00 MINIMUM FEE ADJUSTMENT"4. $4.00 Total Permit Fee: $35.00 FOR PLUMBING INSPECTIONS CALL (509) 477-3675. t Sewer Connection Permit Contractor: COURCHAINE CONSTRUCTION License #: COURCC•181R7 SEWER CONNECTION 1 $85.00 PROCESSING FEE $15.00 Total Permit Fee: $100.00 FOR SEWER INSPECTIONS CALL (509) 43604 UTILITIES 8:30-5:00 PM MONDAY THRU FRIDAY 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'buned cable"Tq •^-' -- CALL BEFORE YOU DIG, (509)156-8000. i STATE LAW RCW 19.122 REQUIRES THAT PRIOR TO ANY EXCAVATION THE °CA11_ 47em cC TGIr a NOTIFIED. CALL BEFORE YOU DIG AT LEAST 2 WORKING DAYS IN ADVANCE, (5 - Ir<^ ,'� �� 1 Spokane CountyCode requires the installer comply with all requirements of the Washington S; �bi /t T those related to trench safety. Processed By: FORRY, JEFF Z d Printed By: WENDEL, GLORIA Page 1 of 2 `_� Voucher ID 00211703 .Vendor ID COURCHAN Invoice # PRJ # 03-7653 Dept ID VENDOR: Courchanine Construction 19818 E Sprague Greenacres WA 99016 Vendor Contact/rel SPOKANE COUNTY PAYMENT DOCUMENT SPOKANE COUNTY AUDITOR SHIP TO: BILL TO: PAGE I OF I Rel Vchr RC# ENTERED DATE: 11/12/2003 PO DATE: BUYER: ACCTG. PERIOD: 11/2003 ENTERED BY: Patt Eickstadt PURCHASING DIRECTOR: BELA G. KOVACS LINE NO. I DESCRIPTION ITEM ID QUANTITY UNIT UNIT PRICE I EXTENDED AMOUNT PO# CHG'ORD# I PO LINE# I PO SCHED# CONTRACT# 1 PLUMBING PORTION OF PERMIT 0.0000 0.00 35.00 0 0 0 LINE NO. DISTRIB LINE ACCOUNT FUND I DEPTID PROGRAM CLASS I RPT CAT I BDPER I PC UNIT TPAY THIS AMOUNT PROJECT ACTIVITY RES.. TYPE CATEGORY SUB CAT AM UNIT PROFILE ASSET FLG ASSET ID 1 1 221003 406 0300008 2003 PROJA 35.00 BACE 240 REFND N Comments: 100% OF PLUMBING PORTION OF PERMIT REFUNDED - SITE LOCATION IS DISCOUNT TOTAL: 0.00 LOCATED IN CITY OF SPOKANE VALLEY'S JURIDICITON. PRJ # 03-7653 FREIGHT TOTAL: 0.00 SITE LOCATION: 1513 N. SARGENT RD.; SPOKANE WA 99212 SALES TAX TOTAL: 0.00 SUBTOTAL: 35.00 USE TAX TOTAL: 0.00 GRAND TOTAL: 35.00 RECEIVING CERTIFICATION Materials noted in quantity • have been received in good condition or contracted for. SIGNED U DATE 11/12/03 TITLE ACCT TECH 4 PAYWNT CERTIFICATION t, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted for this c , e mater n rnished, services rendered or labor performed as described herein o contracted for, th he aim Is a due and unpaid obligation against Spokane County indicated a that i sm anth zed to authenticate and certify to said claim. SIGNED DATE 11/12/03 TITLE OFFICE ADMINISTRATOR TOTAL TO VENDOR: 35.00 TRAVEL CERTIFICATION I hereby certify under penalty of perjury that this is a true and correct claim for necessary expenses incurred by me and that no payment has been received by me on account thereof. SIGNED DATE TITLE