1996, 05-20 Permit App: 96003577 Plumbing ReversalPLInvii3ING PERMIT APPLICATION 94_ 3 S, (7 7
PROJECT ADDRESS:
OWNER: Q4ISir° PHONE: DAYTIME CONTACT
MAILING DR : A S: 447w -44J (d /9 99c9o,4"
(street) ( ty/state) (14))
CONTRACTOR:
MAILING ADDRESS:
j uf
(street)
LICENSE:
PHONE:
state
TcI. No. (509) 456-3675 • Fax No. (509) 324-3198 • TDD No. (509) 324-3166
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in. its programs or activities.
I ;2417
PLUMBING FIXTURES
DESCRIPTION
DE Al
# OF
U T
'Arm-
PUI1D SY
C 0 S1
NIT
..vALs
AMOUNT
B02 TOILETS
WATER CLOSETS. BIDETS
X
S6
=S
I
Si. URINALS
x
S6
=
S
U TUBS
BATH, JACUZZI, SPA. GARDEN
X
S6
=
!BO SHOWERS (per trap)
BASE, STALL, ON —SIT'E BUILD
X
$6
=
S
tit SINKS
1
I
LAYS/BASINS BAR, FLOOR. KITCHEN,
LAUNDRY, mum, JANITOR, PHOTO,
X—RAY, FOOD (PREECULINARY/MEAT)
X
S6
=
B07 DISHWASHER ' •
'
x
S6
=
S
I I:1: CLOTHES WASHER
x
$6
-
S
1130' GARBAGE DISPOSAIJGRINDER
-
X
S6
-
$ 1
I
BII
x
$6
=
$ J
WATER SOI. I ENER
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank, see asechanical)
X
S6
=
$
,1311
131 FLOOR DRAINS
AREA, CASE, COIL, TRENCI-1, CONDENSATE
X
$6
=
$
BL ROOF DRAINS/OVERFLOW DRAINS (ea.)
x
$6
=
B . FOUNTAINS, DRINKING
x
$6
=
S
,,,
13D WATER PIPING/DRAIN-WASTE-VENT/
PLUMBING REVERSALS
INSTALLATION. ALTERATION, REPAIR,
REVERSALS
x
$6
=
S
131* SEWAGE EJECTORS
GRINDER, SUMP PUMP
X
$6
=
S
1317 WATER USING DEVICES
ICE AND/OR COFFEE MAKER.
HOSE BIB, STEAMER. TROOPER.
CARBONATOR, SWAMP COOLERS
X
S6
=
131: CROSS — CONNEL iION DEVICES
VACUUM BREAKER, CHECK VALV
AND R.P.B.P.D. FOR: VATS, Suva's,
TANKS, BOILERS, ,Sc SPRINKLER SYSTEMS
X
=
S,
B • IN i ERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
x
$6
=
.--
S
1321 MEDICAL GAS (per outletibottle station)
NTTROUS, OXYGEN
X
S6
=
5
B21 MISCELLANEOUS FIXTURES
X
56
=
$
Spokane
1026
PEE IS $35.00
Subtotal
NO 1E: MINIMLIM PERMIT
SIGNATURE: /T71 a.--r-L}
"1/4-`
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
S
County Division of Buildings
W. Broadway Avenue • Spokane. WA 99260
-.ii.i :.:.,......,:,....,. .
,:..:•..-:.,-% ... ' . ..
?LEASE:CHECKS PAYABLE TO
' .::: .. H:.:::i ., .:., H ' :::: Y• .
.:SPOKANE COUNTY PERMIT CENTER
.'.:::' , .,, ,
TcI. No. (509) 456-3675 • Fax No. (509) 324-3198 • TDD No. (509) 324-3166
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in. its programs or activities.
I ;2417
SEWER CONNECTION PERMIT
APPLICATION FORM
PLEASE NO 1`h: 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 from the date of issuance. No
extensions will be granted.
Job address:
a1,2
City:
Zip:
Parcel number (if known):
PROJECT INFORMATION i' ''Z
Dry Line
Sewer? (Y/N)
Owner's name:
City/State:
uz . Ge)
Zip: 99�0
Phone:
First-time contractors or home -owners performing the installation must first contact the utilities department (in person
or via phone [456-3604]) before a permit can be issued.
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Contractor (company name):
1� 1 UI q,1 S A -H v e_
Business addrdss:
PC) 'c' -Y.- 11-1-15G,2,
City/State: 300K4r1�
Zip: q qzt -- Phone:
'iA
22- 85oa
State contractor license number:
ALWJWA 4-1.9D(4,P�
Utilities installers permit number:
INTERIOR PLUMBING ALTERATIONS? (yes/no) circle one
Fill out the information in the table below if applicable**
Contractor (if different from above): Phone:
Business Address:
City/State/Zip:
�7r 'I y!,uI;G;
1111111:1 trial
FEE INFORMATION
Sewer Connection: Number of Buildings X (times) $SO (per bldg) = $
TOTAL FEE
* One permit required for each separate building, shop, garage, eta, that will be connected to the sewer.
* Condos, townhouses, & 2- 3 -'and 4 plexes require I permit per address/stub.
* Multiple buildings (apartments, industrial complexes) require 1 permit per building.
(For situations not covered here, call the County Utilities Division @ 456-3604)
APPLICANT SIGNATURE:
Date:
**0444303
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260
PHONE: (509) 456-3675 * FAX: (509) 324-3198 * TDD: (509) 324-3166
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities,
insx5 c\-i.—d —, ,p