2002, 07-25 Permit App: 02006263 Sewer, Plumbing Reversal, Fixtures f !
Project Number: 02006263 Inv: 1 Application Date: 7/25/02 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Peiuiit Use: SEWER CONNECTION-EASTON/TOILET, Contact: COURCHAINE CONSTRUCTION
SHOWER,SINK,REVERSAL Address: 19818 E SPRAGUE
C-S-Z: GREENACRES,WA 99016
Setbacks:Front Left: Right: Rear: Phone: (509)924-5485
Group Name:
Site Information: Project Name:
Plat Key: 000699 Name: EASTON SUB District: F
Parcel Number: 45163.0255 Block: Lot:
SiteAddress: 507 N SKIPWORTH RD Owner:Name: SCHWARTZ,DALE
SPOKANE, I1 A 99206 Address 507 iN SKIPWORTH RI)
Location::SPO SPOKANE,WA 99206
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold: ❑
Area: 0 Sq Ft Width: 80 Depth: 171 Right Of Way(ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Road
Road Obstruction
Released By: •
e 2-6 01.
SSD& Is—
Permits:
s-Permits:
Plumbing Permit
Contractor: BELKNAP PLUMBING Firm: BELKNAP PLUMBING
Address: 3414 S ADAMS RD Phone: (509)921-5913
VERADALE,WA 99037
Item Description Units Unit Desc Fee Amount
TOILETSBIDETS 1 NUMBER OF $6.00
SINKS 1 NUMBER OF $6.00
SHOWERS 1 NUMBER OF $6.00
WATER PIPING-DWV I NUMBER OF $6.00
PROCESSING FEE 1 Y OR BLANK $25.00
Permit Total Fees: $49.00
Operator: CKF Printed By: CKF Print Date: 7/25/02
Project Number: 02006263 Inv: 1 Aj`iplication Date: 7/25/02 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Sewer Connection Permit
Contractor: COURCHAINE CONSTRUCTION Firm: COURCHAINE CONSTRUCTION
Address: 19818 E SPRAGUE AVE Phone: (509)928-0846
GREENACRES,WA 99016
Item Description Units Unit Desc Fee Amount
SEWER CONNECTION 1 NUMBER OF $85.00
PROCESSING FEE 1 Y OR BLANK $15.00
Permit Total Fees: $100.00
Notes:
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Plumbing Permit $49.00 $49.00 $0.00 $49.00
Sewer Connection Permit $100.00 $100.00 $0.00 $100.00
$149.00 $149.00 $0.00 $149.00
Disclaimer:
Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information
contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be contrued to be a permit for,or an approval of,any violation of any of the
provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: CKF Printed By: CKF Print Date: 7/25/02
Spokane County Division of Utilities
SEWER CONNECTION PERM jT APPLICATION FORM
PI.F.ASE NOTE: This 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 form the date of issuance. No extensions will be granted. A separate right-of-way permit is required for any work
performed in or from the county right-of-way.
PROJECT INFORMATION Oa, 0 (0)
Job Address: / ACIP.
Owner's name: ---cg`...4.
Parcel Number. Lot: Block:
Project Name: / t( Address:
ULID Name:
City/State:
[ CHECK APPLICABLE BOXES
lie egular O Residential O New Lip:
CIDry Sewer O Commercial O New Phone: ,.2.E a 44_12.,,
❑ Repair O Temporary
❑ Addition
❑ Abandonment
•
* FIRST TIME CONTRACTORS OR HOME OWNERS PERFORMING THE INSTALLATION MUST FIRST CONTACT THE
UTILITIES DIVISION BEFORE PERMIT(S)CAN BE ISSUED.
SIGNATURE OF UTILITIES DIVISION PERSON CONTACTED:
Contractor(company name): / Sate contractor license number:
Co“Rr.�n r n P. C-0/1.,c
Business address: • * • - . Contact Name:
City/State: Zip:
Phone Number: '/-
1
_INTERIOR PLUMBING ALTERATIONS? ( eno) circle one
Fill out the information in the table below if app/icab e**
Contrac \r different above): Phone:
/
Business Address: City/State/Zip
•
**For plumbing reversal fee information,see reverse side of this form.
FEE INFORMATION �J -
Number of Buildings connecting to sewer X (times)S100(per bldg) =S + S10.00= //V
MI IT OF\\:\y PERMIT
• For a single-family residential unit,one permit is required;
• For a condominium,townhouse,duplex,tnplex ur fourplex with separate ownership(as determined be lot lines)separate address and separate stub,one permit is required per address per stub;
fur.t single building duplex,triplex or fourplex with single ownership,one permit is required
• Multiple buildings(apartments,industrial complexes)with single ownership,one permit required per building connecting to the sewer.
(FOR SITUATIONS NOT COVERED HERE,CALL THE COUNTY DIVISION OF UTILITIES AT 477-3604)
Is any of the work to be performeyLin or from the county right-of-way? LI'1 es O No
( ��
:�PPLIC.\NT SIGN:\TL'RE::�(4,‘,.. D.\IL: AI 41_,
Method� � of Payment:
1;14:ash 0 Check 0 Visa 0 MasterCard 0 Discover Card
Date: Expires;
Bankcard Number:
Authorized Signature:
Spokane County Division of Building&Code I:nfurcument
11126 West Broadway Avenue' Spokane\\.\99260
Tel.No.(509)477-3675' I'ax No.(509)477-7198''ID!)No.(509)477-7133
PLUMBING PERMIT APPLICATION
'ROILC f Pt wl—
\DDRESS: USE:
)\VNER: PHONE (Daytime Contact):
MAILING ADDRESS:
(Street) (City/State) (Zip)
(NIRA\CI'OR: LICENSE:
\JAILING:ADDRESS: P11ONE:
(Street) (City/State) (Zip)
PLUMBING FIXTURES I
#OF MULTI"
um COST/ AMOUNT
DESCRIPTION DETAIL UNITS BY UNIT EQUALS
802 "COLLETS WATER CLOSETS,BIDETS 4 x 56 =
B03 URINALS N SO =
804 TUBS - x SO =
B0S SHOWERS(per trap) BATI I,STALL,ON-SITE BUILD / x SO = t
BOO SINKS LAYS/BASINS,BAR,FLOOR, z SO =
KITCHEN,LAUNDRY,UTILITY,
JANITOR,PI KYR),X-RAY,FOOD
(PREP/CULINARY/MEAT
B07 DISI MASI IER - x SG =
808 CLO'1'I IES\V.\SI II R - x SG =
B09 GARBAGE.DISPOSAL/GRINDIT. - z SG =
810 WATER SOF'll•:NI•:R - N SO =
Bl I ELECTRIC I TOT\Y':\T'ER TANKS (NOTE: if gas water tank see mechanical) N SO =
B12 FLOOR DRAINS .\RE.\,CASE,COIL,TRENCI I, x SO =
CONDI ENS:ATF.
813 ROOF DR INS/O\•LR17.O\Y'DRAINS(ea) - N SO =
B14 FOUNTAINS,DRINKING - N SG =
B15 WATER PIPING/DRAIN-1N WASTE- INSI'A1.LATION,ALTERATION,ION, N SO =
VENT/PLUMBING REVERSALS REP.\IR,REVERSALS
816 SEWAGE EiECIORS GRINDER,SUMP PUMP N SO =
B17 W.VILR USING DEVICES ICE.\ND/OR COFFEE MAKER,I LOSE x SO =
BIB,STEAMER,PROOFI{R,
(:ARBON.VFOR,SWAMP COOLERS
818 CROSS CONNI:(:ETON DEVICES VACUUM BREAKER,(:I IECK\'.VA {, SO =
AND R.P.B.P.D.FOR: VATS,SUMPS.
TANKS,BOILERS,&SPRINKLER
SYSTEMS
B19 INTERCEPTORS GREASE TRAP,SAND'MAP, x SO =
(:I IE\11C:A1.I IOLDING TANK
B20 MI•:DIC.\l.GAS(per outlet/bottle station) NITROUS.OXYGEN N SO =
B21 \IISCI•:1.1.ANEOUS FIXTURES SO =
METHOD OF PAYMENT SUBTO'I'.\l. q
IIMIN VISAIICOVE` PLUS PROCESSING FEES 25.00
0 c.\sl I ❑ cI 0.:(:K ❑ !!®i ❑ ❑ '-- - ..
t\\I-.0 PERMITS\\)I.1.07•1.1.ttt. 4t:CI PIT.D\\,,,I t'.\',\Ii\,-
r \NI Nttitt CRF1)1.1 c:rrtu T'(YI'.AL.PERMIT FEE DUE 4/
DATE: EXPIRES: /
MINIMUM PERMIT FEE IS$35.00
14\NK(:.\RD NUNBI:R: PLEASE MAKE a IECKS PAYABLE TO
SPOKANE COUNTY PERMIT CENTER
\t'TI TORI'/.I:1)SIGN\TORI{:
Spokane Counts Divi>ion of Buildint&Coils I•:nf,rccmcnl
in26\\c,.t Bro,idwac.\emus ' Spokane W. 9926'
Tel.No.(5119)477-3675' Fix No.(5119)477-719$ ' 11)1)No.(509)477-7133