HomeMy WebLinkAbout2004, 02-19 Permit App: BLD-04-03584 Mechanical Fixturesla YtKIVIII AYYLI LA11VIN /r\
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ADDRESS: f /U 2 /Y r Locus 'J /d ,' .•
PERMIT
USE
OWNl gffg%, �/ ^/ 2 [ iig-/- 6 de //„ L jJ
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PHONE (Daytime Contact):3,-0QryA
9 //d V _ Y� 6 8
M iLr4DL�rX /3/1/ sp�,�i1�T lnaev0 z J% 9�at3
(Street) • (City/State) .(Zip)
CONT CTOR: _/� y/ ] r, -e /eze
eel/Yor
LICENSE:
MAILING ADDRESS: J
e6/..'IC '2cr?r i3//"/
PHONE:
9a®- g200I3,.
JIfo/£'i9n/c 446e-67 4i 99-2/3
(City/State) • . - (Zip)
(Street)
PLUMBING FIXTURES I
DESCRIPTION
DETAIL
# OF
UNITS
MPLIOLYB
ED
BY
COST/
UNIT
Epuus
AMOUNT
'IBOV
TOILETS
WATER CLOSETS, BIDETS
x
$6
=
FB03'-
URINALS
N
56
=
1B041
TUBS
-
x
$6
=
BO5I)
SHOWERS (per trap)
BATH, STALL, ON-SITE BUILD
x
$6
=
-B064
SINKS
le\VS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD
(PREP/CULINARY/MEAT
I
.x
$6
=
£BOZ'.
DIS]IWASIIER
-
x
56
=
)BOBI"
CLOI'I IES WASHER
-
t
x
$6
=
•B09;i
GARBAGE DISPOSAL/GRINDER
-
N
- $6
=
B101
WATER SOFTENER
-
x
S6
=
41131 l
ELECTRIC I MOI' WATER'TANKS
(NOPE: if, gas water tank see mechanical
N
$6
=
B12:
''r1j-:I
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
x
56
=
i B13:
ROOT: DRAINS/OVERFLOW DRAINS
-
x
$6
=
.B14'
FOUNTAINS, DRINKING
-
x
S6
=
B15.
,E...:•:
WATER PIPING/DRAIN-IN WASTE-
VENT/PLUMBING REVERSALS
INSTALLATION, ALTERATION,
REPAIR. REVERSALS
x
56
=
!BIG-
SEWAGE EJECTORS
GRINDER, SUMP PUMP
/
x
S6
=
:B17-
\X'ATER USING DEVICES
ICE AND/OR COFFEE MAKER, I IOSE
BIB, STEAMER, PROCTER,
CARBONATOR, SWAMP COOLERS
N
56
=
•
rB18i
CROSS CONNECTION DEVICES
_
VACUUM BREAKER, CHECK VALVE,
AND R.P B P D. FOR VATS, SUMPS,
TANKS, BO1I,ERS, & SPRINKLER
SYSTEMS
56
=
'tB19.
'.'. `I
INTERCEPTORS
GREASE'IRAP, SAND TRAP,
CHEMICAL 1 IOLDING TANK
N
56
=
:B20`
MEDICAL GAS (per outlet/bottle station)
NITROUS, OXYGEN
N
56
=
10321<
MISCELLANEOUS FIXTURES
56
=
METHOD
OF PAYMENT
®
V/S4■
;1. ,:
,rte, -, ■
rim All II P 11)IENT
I C \IID
L.
SUBTOTAL
PLUS PROCESSING FEE
5
'
25.1N1
.DMC®VER'
:ir ,
-^ �"'
■ CASA
■ CIIl±CK ❑
P \\I D PER\Ill S WILL ONLI 131:.\CCPV
OF \ \I yOlt CitiIDi
EXPIRES:
DATE'
BA\NKCARD
.\UTI
"1'O'1)\I, PI72\11'1' El (11 DUE
.'• ' MINIMUM PERMITTEE IS $35 00 -
PLEASE MAKE CHECKS PAYABLE TO , '.
SPOKANE COUNTY PERMIT CEN TER "•_
-
. -.
NUMBER.
TORI%ED SIGNATURE:
Spokane County Division of Building & Code Enforcement
1026 West Broadway Al enue Spokane WA 99260
'I'd. No (509) 477-3675 Fax No (509) 477-7198' TDD No. (509) 477-7133
Spokane County Division of Utilities
SEWER CONNECTION PERMIT APPLICATION FORM
PLEASE NOTE: This application form must be filled out accurately and in tis 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.
job Address: 102. N. Locc,S+
Parcel Number45 I, z • 1151 Lae
Project Name: Vaal MIA
PROJECT INFORMATION
81st c�
CHECK APPLICABLE BOXES
Regular
❑ Dry Sewer
❑ Repair
❑ Addition
❑ Abandonment
XResidential
E Commercial
O Temporary
O New
O New
owner's name: 111euho .111•4 L-eMC ITty k a A
ani
Address: • t Da W no 13 ' I 1
City/State: spa /LTL dALLc' ja t • _ `.•.
Zip: 99(2./.3 •t
Phone: Q �I //q24 - ;133 f-`
* 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:
Coqnrytractorjcompany qa e s e�
Ls&Ca—AL IM SC 2.t S
Business addre s:PU' �(OY.. I34"�LOA
City/State:�lUN, xLL:1rAtLEY r A - zip: "1 "IoL/J
Satumber:
Enfg t=ractor 141 tVIY
AA e
Contact Name: in kJ.— 4 LL
Phone Number. We- lea/a
INTERIOR PLUMBING ALTERATIONS?
Fill out the information in the table below if (oh
no) circle one
Contractor (if different from above): Phone:
Business Address:
City/State/Zip
**For plumbisgreversal fee information, se- reverse side ofthii forth.` • '
FEE INFORMATION god
Number of Buildings connecting to sewer 1 X (times) 5100 (per bldg) = S %Oa +" iu,uV=
• For a single-family residential unit, one permit is required,
• For a condominium, townhouse, duplex, tnplex or fourplex with separate ownership (as determined bs lot line') separate address and separate stub, one permit is required per address per stub,
• Fora single building duplex, tnplex or fourplex with single ownership, one permit is required
• Multiple buildings (apartments, ndustnal complexes) with single ownership, one permit required per budding connecting to the sewer.
RIGIn OF tell' FERMI r
r; (FOR SITUATIONS NOT COVERED HERE, CALL THE COUNTY DIVISION OF UTILITIES AT 477-3604)
Is any of the work to be performed in or from the yeeittiy right-of-way? O Yes El No
APPLICANT SIGNATURE: DATE:
Method of Payment:
D Cash O Check 0 Visa
0 MasterCard 0 Discover Card
Date: Expires:
Bankcard Number:
Authorized Signature:
Spokane County Division of Building A Code Enforcement
1026 West Broadway AvenueSpokane WA 99260
Tel. No (509) 477-3675 * Fax No. (509) 477-7198 * IDD No. (509) 477-7133