2002, 06-05 Permit App: 02004433 Sewer, Plumbing Reversal Project Number: 02004433 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 & PLUMBING Contact: COURCHAINE CONSTRUCTION
REVERSAL 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: 45084.0457 Block: Lot:
SiteAddress: 1707 N UNIVERSITY RD Owner: Name: JACOBS,KENT&KAMMIE
SPOKANE,WA 99206 Address: 1707 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
Road Obstruction Released 41A,
Permits:
Plumbing 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
WATER PIPING-DWV 1 NUMBER OF $6.00
PROCESSING FEE 1 Y OR BLANK $25.00
MINIMUM FEE ADJUSTMENT I Select $4.00
Permit Total Fees: $35.00
Operator: RMB Printed By: RMB Print Date: 6/5/2002
Project Number: 02004433 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
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
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Plumbing Permit $35.00 $35.00 $0.00 $35.00
Sewer Connection Permit $100.00 $100.00 $0.00 $100.00
$135.00 $135.00 $0.00 $135.00
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: RMB Printed By: RMB Print Date: 6/5/20112
Spokane County Division of Utilities �/j
SEWER CONNECTION'PERMIT APPLICATION FORM `C`�
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 arc
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: f a) H .
Owner's name: 1\i!
Q b
Parcel Number: Lot: Block:
Project Name: Address: rs' al.
ULID Name:
City/State:
CHECK APPLICABLE BOXES
Regular CIResidential CINew Zip
❑ Dry Sewer ❑ Commercial Cl New
Phone:
❑ Repair ❑ 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:
Co• actor(company na c): �c� r Sate contractor license number:
_ ''"UU �
. I , ErSp
'1 CC ' ` 1
•Business address: �^� Contact Name:
City/State:Gize_efv8-0,.-5 (13a. Zip'9701 he, e_
Phone Number:
INTERIOR PLUMBING ALTERATIONS?Ono)no) circle one
Fill oat the information in the table below if apple e**
Contractor(if different from Phone:
s�l�� 6
Business Address: City/State/Zip
**For plumbing reversal fee information,see reverse side of this form.
FEE INFORMATION
Number of Buildings connecting to sewer 3 X (Bines)S100(per bldg) =S + S10.00=
RIGtI'I Oi 55 ci ciR\tiI
• For a single-Emily residential unit,one permit is required;
• For a condominium,townhouse,duplex,triplex or 1.urplec w ith separate ownership(as determined br lot lines)separate address and separate stub,one permit is required per address per smb;
• For a single budding duplex,triplex or fourples with single ownership,one permit is required
• Multiple buildings(apartments,industrial complexes)with single ownership,tins 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 performs in or from the county right-of-way?pl Yes ❑ No
APPLICANT SIGN.\"I'URI D:\"1'I:: J S a
Method of Payment:
❑ Cash ❑ Check 0 Visa 0 MasterCard 0 Discover Card
Date: Expires:
Bankcard Number:
.Authorized Signature:
PLUMBING PERMIT APPLICATION
I'Rosti(:T PERMIT
ADDRESS: USE:
O\VNI:R PHONE (Daytime Contact):
MAILING ADDRESS:
(Street) �q (City/State) �j (Zip)
CON'1'D:nco 1 N•P_ C.a rt. LICENSE b' I C.C.
46 1Q'W�
MAILING ADDRESS: PHONE: 9,1 tit
-5(/d s
14 s is s'PK �_ lOC`f
GIZee_IIPt-Q5Y_ Oa_ 19ci
(Street) (City/State) (Zip)
PLUMBING FIXTURES I
#OF MULTI- COST/ AMOUNT
DESCRIPTION DETAIL UNITS P BYD UNIT EQUALS
B02 TOILETS WATER CLOSETS,BIDETS x $6 =
B03 URINALS ` $6 =
B04 TUBS
- x so =
B05 SHOWERS(per trap) BATH,STALL,ON-SITE BUILD x $6 =
B06 SINKS LAYS/BASINS,BAR,FLOOR, x $6 =
KITCHEN,LAUNDRY,UTILITY,
JAN um,PHOTO,X-RAY,FOOD
(PREP/CULINARY/MEAT
B07 1)1S1IWASHER
x $G =
B08 CI.O Il-I S WASHER x SO =
B09 GARBAGE:DISPOSAL/GRINDER _ s $6 =
BIO WATER SOFTENER - x $6 =
B11 ELECTRIC ITOT WATER TANKS (NOTE: if gas water tank see mechanical) x SO =
B12 FLOOR DRAINS AREA,CASE,COIL,TRENCI I, x SO =
CONDENSATE
B13 ROOF DRAINS/OVERFLOW DRAINS(ca) - x SO =
B14 FOUNTAINS,DRINKING - x SO =
B15 \\'.II ?R PIPING/DRAIN-IN WASTE- INSTALLATION,ALTERATION, x SO =
VENT/PLUMBING REVERSALS REPAIR,REVERSALS
B16 SI AVAGE FILCTORS GRINDER,SUMP PUMP x SO =
B17 WATER USING DEVICES ICE AND/OR COFFEE MAKER,I IOSE x SO =
BIB,_STEAME:R,PROOFER,
(:A RBONAT'OR,SWAMP COOLERS
B18 (.ROSS CONNECTION DEVICES VACUUM BREAKER,(:HECK\':\INE, SO =
:\ND R.P.B.P.D.FOR: V:VIS,SUMPS,
TANKS,BOILERS,&SPRINKLER
SYSTEMS
B19 INTERCEPTORS GREASE TRAP,SAND TRAP, x SO =
CHEMICAL HOLDING TANK
B20 MI.:DIC.\l.GAS(per outlet/bottle station) NITROUS,OXYGEN \ SO =
B21 MISCI-;J.L:\NNOUS FIXTURES
So =
METHOD OF PAYMENT
SUBTOTAL
MEMME ,VISA : MCMV
PLUS PROCI.:SSING I'I':I{ S 25.00
9 c.5511 ❑ clIFcK ❑ ❑ ❑
I.\\I(D Nit\HT,:win 0\I\ III. \CCIII'Ii(1)0111!P.V) L\1- .
OF \\I\ )R CREDIT C.1RD
I O l.U.PERMIT 1'1'.1'1 DUI'.
D511.:: EXPIRES: MINIMUM PERMIT FEE IS$3500
PLEASE MAKE(7IECKS PAYABLE 10
B WKC-\RU NUMBER: SPOKANE COUNTY PERMITCENT1iR
:WTI IORI/I:D SIGNATURE.
Spokane County Division of Building&Code Enforcement
1020 West Broadway:\venue' Spokane,WA 99200-1)050
Telephone Nn.(509)477-3075' Fax No. 477-7198'TDI)No. (509)477-7133