2002, 06-05 Permit App: 02004432 Sewer Project Number: 02004432 Inv: 1 Application Date: 6/5/2002 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: SEWER CONNECTION-EASTON Contact: COURCHAINE CONSTRUCTION
Address: 19818 E SPRAGUE
C - S -Z: GREENACRES,WA 99016
Setbacks: Front Left: Right: Rear: Phone: (509)924-5485
Group Name:
Project Name:
Site Information:
Plat Key: 001836 Name: OPP.TR. 1-354 District: F
Parcel Number: 45084.0450 Block: Lot:
SiteAddress: 1703 N UNIVERSITY RD Owner:Name: JACOBS,KENT& KAMMIE
SPOKANE,WA 99206 Address: 1703 N UNIVERSITY RD
Location::SPO SPOKANE,WA 99206
Zoning: UNK
Water District: Hold: ❑
Area: 1.00 Acres Width: 0 Depth: 0 Right Of Way(ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 1
Review Information:
Review 4
Road Obstruction Released By: s 510
Permits:
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 I Y OR BLANK $15.00
Permit Total Fees: $100.00
Operator: RMB Printed By: RMB Print Date: 6/5/2002
Project Number: 02004432 Inv: 1 Application Date: 6/5/2002 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes .
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Sewer Connection Permit $100.00 $100.00 $0.00 $100.00
$100.00 $100.00 $0.00 $100.00
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 he 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: RMB Printed By: RMB Print Date: 6/5/2002
Spokane County Livisid`ff of Utilities c CjL(3
SEWER CONNECTI( N PERMIT APPLICATION FORM
PLEASE 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
Job Address: 1 ) 0 3 N (..„ J L
Owner's name: (�',be j[o S
Parcel Number: Lot: Block:
Project Name: Address: J '7 a 7
ULID Name:
City/State:
CHECK APPLICABLE BOXES
Regular O Residential 0 New Zip:
❑ Dry Sewer 0 Commercial 0 New
Phone:
❑ Repair 0 "Temporary
❑ Addition
U Abandonment
* FIRST TIME CONTRACTORS OR HOME OWNERS PERFORMING THE INSTALLATION MUST FIRST CONTACT THE
UTILITIES DIVISION BEFORE PERMITS)CAN BE ISSUED.
SIGNATURE OF U I lLI'I'IES DIVISION PERSON CONTACTED:
Co• ctor(company name): , t Sate contractor license number:
"-to(A c�' \ € Cot6+,
I . Et SP I
Business address:nAi• ` lr� Contact Name:c3(
( �1 ��}Z
City/State:Gp�P_flNtik�s WG. rip.WO/ 6 ' _(� AI
Phone Number: q J'4 S T 3
INTERIOR PLUMBING ALTERATIONS? (ye AID circle one
Fill out the information in the table below if applicable*
Contractor(if different fromalb Phone:
sf�. a S
Business Address: City/State/Zip
**For plumbing reversal fee information,see reverse side of this form.
FEE INFORMATION
Number of Buildings connecting to sewer X (times)S100(per bldg) = S + S10.00=
RIGI ri Ur‘V. m'r:R\tIT
• For a single-family residential unit,one permit is required;
• For a condominium,townhouse,duplex,triples or fuurplex with separate ownership(as determined bs Int lines)separate address and separate stub,one perrnit is required per address per stub;
• For a single building duplex,triplex or Gourples with single ownership,one permit is required
• hlultiple building:(apartments,industrial complexes)with single ownership,one permit required per budding 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 performed or from the county right-of-way? Yes 0 No
Xf
APPLICANT SIGNATURE: - D,VI'I•::(J,-,-`Q. -3-- a
Method of Payment:
❑ Cash 0 Check 0 Visa ❑ MasterCard 0 Discover Card
Date: I'spires:
Baukcard Number:
Authorized Signature:
PLUMBI$J'G PPR.MIT APPLICATION
-,
PROJECT PERMIT'
ADDRESS: USE:
OWNER. PHONE (Daytime Contact):
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTO : LICENSE:
a) : CoL1 al Re_ r�Lob(--('R CC 1 �I t��
•
MAILING ADDRESS: PHONE: %Z.
y l S Y e•5
14g is el s'PK( �_ 7oC d
Grze1kQS O g9n1
(Street) (City/State) (Zip)
PLUMBING FIXTURES
#OF MULTI- COST/ AMOUNT
DESCRIPTION DETAIL PLED
UNITS BY UNIT EQUALS
B02 TOILETS WATER CLOSETS,BIDETS x $6 =
B03. URINALS ` $6 =
B04 TUBS - x $6
-B05 SI-TOWERS(per trap) BATH,STALL,ON-SITE BUILD x $6 =
B06 SINKS LAVS/BASINS,BAR,FLOOR, x $6 =
KI'T'CHEN,LAUNDRY,UTILITY,
JANITOR,PI-IOTO,X-RAY,FOOD
(PREP/CULINARY/MEAT
B07 DISHWASHER - x 56 =
B08 CLOTHES WASHER - x S6 =
B09 GARBAGE DISPOSAL/GRINDER - \ $6 =
BIB WATER SOFTENER - x $G
B11 ELECTRIC(TRIC ITOT WATER TANKS (NOTE: if gas water tank sec mechanical) X SO =
B12 FLOOR DRAINS AREA,CASE,COIL,TRENCI I, x SO =
CONDENSATE
B13 ROOD DRAINS/OVERFLOW DRAINS(ca) - ` SO =
B14 FOUNTAINS,DRINKING - ' SO =
B15 WATER PIPING/DRAIN-IN WASTE- INSTALLATION,ALTERATION, z SO
\'I':NT/PLUMBING REVERSALS REPAIR,REVERSALS
816 SEWAGE EJECTORS GRINDER,SUMP PUMP , SO =
B17 WATER USING DEVICES ICE AND/OR COFFEE MAKER,I LOSE N SO =
BIB,STEAMER,PROOFFR,
C\RBON:\T'OR,SWAMP COOLERS
B18 CROSS CONNECTION DEVICES VACUUM BREAKER,(:HECK VAINE, SO =
.\NI)R.P.B.P.D.FOR: VATS,SUMPS,
TANKS,BOILERS,&SPRINKLER
SYS'IT•:MS
B19 INTERCEPTORS GREASE TRAP,SAND TRAI', N SO =
CI IEMICAI.HOLDING TANK
B20 MEDICAL GAS(per outlet/bottle station) NITROUS,OXYGEN - SO
B21 MISCELLANEOUS FIXTURES S6
METHOD OF PAYMENT tiUB'LO'1.\1
tCO>cVESA P1(I' PRO(I:SSING 1 I.I: S 25.00
❑ CASH ❑ CII:CK ❑ ❑ Z-4a.,
❑ '�
P.\\ED alk\IIT'-\\IIi.()MN BE\CCI:I'TI[t)\\1771 I'.\l\IP:\T
01: \\I\Il)R CREDIT C.\RD
I O I-\l.PERMIT FEE DUE
U:\1 1 : EXPIRES:
MINIMUM PERMIT FEE IS$35.00
PLEASE MAKE CI IECKS PAY:\BIF'l'O
B\NTC.\RD NUMBER:
SPOKANE COUNTY 1'I•:R,MITCENTIT.
AUTT IORIZI:D SIGNATURE:
Spokane County Division of Building&Code Enforcement
1(126 West Broadway Avenue Spokane,WA 992611-015t1
-Telephone No.(509)477-3075' Fax No. 477-7198'TDD No. (509)477-7133