1994, 10-21 Permit App: 94010477 Plumbing FixturesI . ►
946 ./169
SEWER CONNECTION PERMIT
44Io1-1TA
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:
1C11---
Owner' e:
7,--(wK --2.)--te.40-2i
.5---°7-2-zal-e-
.1_7‘/
City: ,i
City/State: ,,_er,,..y,e
_,i
Zip: 0., r ,
Zip:
_
Parcel number (if known):
Phone: �7
9: 2r �'cC/
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):
A-r-m3a-,-or cons-i'r a a -I -i ori
State contractor license number:
,A.QM.S1 L* i G 2 til 1
3
Business address:
Po 6 t)c. 11-1-2./S2,
Utilities installers permit number:
City/State: ,S p r e-\A/A
Zip: q q 2t aPhone: q 2, 13 - DSS c3
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) = $ v
TOTAL FEE
(One permit required for each separate building, shop, garage, etc., that will be connected to the sewer)
Date: A.2/ /%,
APPLICANT SIGNATURE:
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675
PLUMBING PERMIT .APPLICATION
PROJECT ADDRESS:
qui Ipwi`7
OWNER:
PHONE:
MAILING ADDRESS:
CONTRACTOR: o 4r- � CA/1
MAILING ADDRESS:
_ •
(street)
(city/state)
(ZiP)
LICENSE: AC) �' J Q O/ r 8 1
PHONE:
re_ P.n. acres WA q ct o t
(street)
(city/state) (zip)
PLUMBING FIXTURES
DESCRIPTION DETAIL
# OF
UNITS
MULTI-
PLIED BY
COST
/UNIT
EQUAL
AMOUNT
B03
TOILETS
URINALS
WATER CLOSETS. BIDETS
x
x
$6
$6
S
S
6
B04
TUBS
BATH JACUZZI, SPA. GARDEN
x
$6
S
305
B06
SHOWERS (per trap)
BASE, STALL, ON—SITE BUILD
x
$6
$
SINKS
LAVS/BASINS. BAR. FLOOR. KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X—RAY, FOOD (PREP/CULINARY/MEAT)
x
$6
$ 6
B07
DISHWASHER
x
$6
S
B08
CLOTHES WASHER
x
$6
B09
GARBAGE DISPOSAL/GRINDER
x
$6
S
B1Q
WATER SOFTENER
x
$6
S
B11
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank, see mechanical)
x
$6
S
B12
FLOOR DRAINS
AREA. CASE, COIL., TRENCH CONDENSATE
x
$6
S
B13
ROOF DRAINS/OVERFLOW DRAINS (ea.)
x
S6
S
B14
FOUNTAINS, DRINKING
x
$6
1315
WATER PIPING/DRAIN—WASTE—VENT/
PLUMBING REVERSALS
INSTALLATION. ALTERATION, REPAIR
REVERSALS
x
$6
$
B16
SEWAGE EJECTORS
GRINDER. SUMP PUMP
x
$6
S
1317
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB. STEAMER PROOFER.
CARBONATOR SWAMP COOLERS
x
$6
S
B1:8
CROSS—CONNECTION DEVICES
VACUUM BREAKER CHECK VALVE,
AND R.P.B.P.D. FOR: VATS SUMPS,
TANKS, BOILERS, & SPRINKLER SYSTEMS
x
$6
S
8.19
INTERCEPTORS
GREASE TRAP, SAND TRAP.
CHEMICAL HOLDING TANK
x
S6
S
B20
MEDICAL GAS (per outlet/bottle station)
NITROUS, OXYGEN
x
$6
S
B21
MISCELLANEOUS FIXTURES
x
$6
S
NOTE: MINIMUMPERMIT FEE IS $35.00
SIGNATURE:
Spokane County Division of Buildings
1026 W. Broadway Avenue • Spokane, WA 99260
Tel. No. (509) 456-3675 * Fax No. (509) 456-4703 * TDD No. (509) 324-3166
,MASTERVLUMPER LHND
Subtotal
PLUS: PROCESSING FEE
$2$.00
TOTAL PERMIT FEE DUE
$17.
PLEASE MAKE CHEC
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SPOKANE COUNTY�PE
.........................................................
PARABLE :
TO
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