1994, 10-18 Permit App: 94010352 Plumbing ReversalPLUMBING PERMIT APPLICATION
PROJECT ADDRESS: .S'c� /-// i11
OWNER: C/G- / l l !' ie/1//
PHONE: 9z, ¢5/(
MAILING ADDRESS: ,S0 /%/,/ `/./"9,2/7,9//1
CONTRACTOR:
MAILING ADDRESS:
(street) (city/state)
(Zip)
LICENSE:
PHONE:
(street)
(city/state)
(zip)
Tel. No. (509) 456-3675 Fax Fax No. (509) 456-4703 s TDD No. (509) 324-3166
\ MASTER \PLU MPER M.HN D
PLUMBING FIXTURES
DESCRIPTION
DETAIL
# OF
UNITS
win-
runosy
COST
/UNIT
suuALS
AMOUNT
B02
TOILETS
WATER CLOSETS, BIDETS
X
$6
=
$
B03
URINALS
-
x
$6
=
$
1304
TUBS
BATH, JACUZZI, SPA, GARDEN
X
$6
=
$
1305
SHOWERS (per trap)
BASE, STALL ON—SITE BUILD
x
$6
=
$
1306
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X—RAY, FOOD (PREP/CULINARY/MEAT)
x
$6
=
$
1307
DISHWASHER
-
x
$6
=
$
B0$
CLOTHES WASHER
-
x
$6
=
$
B09
GARBAGE DISPOSAUGRINDER
-
x
$6
=
$
B10
WATER SOFTENER
-
x
$6
=
$
B11
ELECTRIC HOT WATER TANKS
(NOTE: if gas water lank, see mechanical)
X
$6
=
$
B12
FLOOR DRAINS
AREA, 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/
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
I
//
X
$6
=
$
PL „ : _ ' VERSALS
VERS M
1316
SE" ' . — 2 RS--___ -------_
GRINDER, SUMP PUMP
x
$6
=
$
1317
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLERS
x
$6
=
$
B1$
CROSS -CONNECTION DEVICES
VACUUM BREAKER.CHECK VALVE.
AND R.P.B.P.D. FOR: VATS, SUMPS,
TANKS, BOILERS, & SPRINKLER SYSTEMS
x
$6
=
$
1319
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
=
$
Spokane
1026
NOTE: MINIMUM PERMIT EE IS $35.00
SIGNATURE:
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
S
County Division of Buildings
W. Broadway Avenue ' Spokane, WA 99260
PLEASE MAKE CHECKS PAYABLE TO:
SPOKANE COUNTY PERMIT CENTER
Tel. No. (509) 456-3675 Fax Fax No. (509) 456-4703 s TDD No. (509) 324-3166
\ MASTER \PLU MPER M.HN D
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.
PROJECT INFORMATION
Job address:
Owner's name:
City:
City/State:
Zip:
Zip:
Parcel number (if known):
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:
Utilities installers permit number:
City/State:
Zip:
Phone:
INTERIOR PLUMBING ALTERATIONS (if applicable)**
Contractor (if different from above): Phone:
Business Address:
City/State/Zip:
** 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 permit required for each separate building, shop, garage, etc., that will be connected to the sewer)
APPLICANT SIGNATURE:
Date:
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675
OFFICE OF THE COUNTY ENGINEER •
Ronald C. Hormann, P.E., County Engineer
MEMO
DATE: 10/17/94
TO: Jim Legat
FROM: Bill Johns
RE: University Place ULID
All the lines are released for connection.
The following need to be released immediately:
A DIVISION OF THE PUBLIC WORKS DEPARTMENT
Dennis M. Scott, P.E., Director
1. South 1111 Mariam
2. East 10602 14th
3. East 10213 16th
�, CQJf /a1L/6 /3 MI
1026 W. Broadway Ave. • Spokane, WA 99260-0170 '• (509) 456-3600 FAX: (509) 324-3478 TDD: (509) 324-3166