1995, 02-27 Permit App: 95001003 Plumbing ReversalPLUMBING PER�4IT APPLICATION
fECT ADDRESS: D,
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OWNER: �f eYi PIIONE: - 3
MAILING ADDRESS:EA
k) i C' (j
(street) (ci y/state) (zip)
MAILING ADDRESS: I � � 2� ��-f h !�j C(-1CAr Cis �%� � Q til t -
(street) (city/state) (zip)
1 et. NO. (SUY) 456-3675 ' Vaz No. (509) 456-4703 • TDD No. (509) 324-3166
-STHRVL MFERKHND
PLUMBING FIXTURES
DESCRIPTION DETAIL
# OF
UNITS
MVLn-
iLIHDBY
I COST
NIT
a DA13
AMOUNT
$02
TOILETS
WATER CLOSETS, BIDETS
x
$6
=
$
B03
URINALS
—
x
$6
=
$
TUBS
BATH, JACUZZI, SPA, GARDEN
x
$6
=
$
BO$
SHOWERS per trap
BASF,STALI, ON— SITE BUILD
x
$6
=
$
1306
SINKS
LAVSBASINS, BAR, FLOOR. KITCHEN,
LAUNDRY, UTILITY, JANITOR PHOTO,
X—RAY, FOOD REP"MINARY/MEA
x
$6
=
$
B07
DISHWASHER
-
x
$6
=
$
B08
CLOTHES WASHER
-
x
$6
=
$
B09
GARBAGE DISPOSAUGRINDER
-
x
$6
=
$
B10
WATER SOFTENER
-
x
$6
=
$
1311
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank, see mechanical)
x
$6
=
$
912
FLOOR DRAINS
ARTA, CASE, COIL, TRENCH, CONDENSATE
x
$6
=
$
B13
ROOF DRAINS/OVERFLOW DRAINS ea.
-
x
$6
=
$
B14
FOUNTAINS, DRINKING
-
x
$6
=
$
B15
WATER PIPING/DRAIN-WASTE-VENT/
PLUMBING REVERSALS
IN_STALLATION,ALTERATION, REPAIR,
REVERSALS
x
$6
=
$
B16
SEWAGE EJECTORS
GRINDER SUMP PUMP
x
$6
=
$
B17
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR SWAMP COOLERS
x
$6
=
$
B18
CROSS -CONNECTION DEVICES
VACUUM BREAKER CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, SUMPS,
TANKS, BORERS, & SPRINKLER SYSTEMS
x
$6
=
$
B19
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
x
$6
=
$
B20
MEDICAL GAS(per outlet/bottle station
NITROUS, OXYGEN
x
$6
=
$
B21
MISCELLANEOUS FIXTURES
x
$6
=
$
NOTE: MINIMUMPERMIT FEE IS $35.00
SIGNATURE:
Spokane County Division of Buildings
1026 W. Broadway Avenue • Spokane, WA 99260
Subtotal
PLUS: PROCESSING FEE
$2.5.00
TOTAL PERMIT FEE DUE
PLEASE MAKE ;CHECKS PA XABLE T..Q;
SPOKANE COUNTY PERMIT CENTER.:.
1 et. NO. (SUY) 456-3675 ' Vaz No. (509) 456-4703 • TDD No. (509) 324-3166
-STHRVL MFERKHND
*r
SEWER CONNECTION 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.
PROTECT INFORMATION
Job address:
Owner's name:
City:
City/State:
Zip:
Zip:
Parcel number (ifkno,n):
Phone:
WILL THE PROPERTY OWNER BE PERFORMING THE SEWER CONNECTION
INSTALLATION?* Yes No
*If property owner is installing the sewer connection, they must first contact the UTILITIES DEPARTMENT for construction
requirements before the permit is issued.
CONTRACTOR INFORMATION
Contractor (company name):
State contractor license number:
Business address:
!: , 9E� L (n 66-0 n CA `,Jn. I
Utilities installers permit number:
City/State: \ 5 r7 f- WA
Zip: q q�L 12 Phone: (rr�,q I- q G L- q
T1kT1T11r""Tt-%" "Y T Tl /TITIN Y! ♦ Y -
JL11 iLiuvn ri.vivJLD11N%-J IC11.1zitti11V1V3 (if applicable)"
Contractor (if different from above): Phone: q2 -r) - q D g cA
Business Address: City/State/Zip:
o
** For plumbing reversal fee information, see reverse side of this form.
FEE INFORMATION
Sewer Connection: Number of Buildings X (times) $50 (per bldg _ $
TOTAL FEE
(One pennit required for each separate building, shop, garage, etc., that will be connecter) to the sewer)
APPLICANT SIGNATURE:
Date:
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675