1994, 08-29 Permit App: 94008385 Seweriv , Pok)
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91
SEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND
SIGNED OR PERMIT WILL NOT BE ISSUED.
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L(1F KNOWN)
JOB ADDRESS:PARCEL NUMBER:
/ 3`�
CITY:S1�rr) ((P\ N) E STATE: WA . ZIP CODE:
rye S --t-- (j 1` ID _s ADDRESS:
CITY: S D A. fly ki STATE: LA)/4 _ ZIP CODE:
PHONE NUMBER: c1(. a I 1 4
OWNER NAME:
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES
(CIRCLE 0
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR:
CITY: -_12nrIleNrkrNr,
PHONE NUMBER: Ci2_,r1 -
STATE CONTRACTORS LICENSE NUMBER: 'L G. G 0 - - & 1- Y' 1 M
ADDRESS: I3�I1,::. L . 12,44
STATE: t4A- ZIP CODE: q G
UTILITIES INSTALLERS PERM T,NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE)
INTERIOR ALTERATION BY:
ADDRESS: PHONE NUMBER:
CITY: STATE: ZIP CODE:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION •# OF BUILDINGS ( X 50.00 =
INTERIOR PLUMBING ALTERATIONS:# OF BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $<c-)_
APPLICANT
SIGNATURE:
DATE:? -,;?;?-2 /
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER:
PHONE:
MAILING ADDRESS:
CONTRACTOR:
(street) (city/state)
(zip)
LICENSE:
PHONE:
MAILING ADDRESS:
(street)
(city/state)
(zip)
SIGNATURE:
SPOKANE COUNTY DIVISION OF BUILDINGS
WEST 1026 BROADWAY AVENUE' SPOKANE, WA 99260 * (509) 456-3675
PLUMBING FIXTURES
DESCRIPTION. DETAIL
#��0�1:
.,OLn-
'um BY
COSI'
/UNIT
BQu,a.s
AMOUNT
VNITS
TOILETS
WATER CLOSETS, BIDETS
X
$6
=
$
URINALS
—
x
$6
=
$
`TUBS
BATH, JACUZZI, SPA, GARDEN
X
$6
=
$
F 5X
SHOWERS (per trap)
BASE, STALL, ON-SITE BUILD
$6
=
$
r
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD (PREP/CULINARY/MEAT)
X
$6
=
$
DISHWASHER
—
...ti ., •
x
$6
=
$
CLOTHES WASHER
—
GARBAGE DISPOSAL/GRINDER
— -
x
$6
=
$
Hifi
WATER SOFTENER
—
x
$6
=
$
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank, see mechanical)
x
$6
=
FLOOR DRAINS
AREA, CASE, COIL, TRENCH. CONDENSATE
X
$6
=
$
.t
ROOF DRAINS/OVERFLOW DRAINS (ea.)
-
x
$6
=
$
BL?I
FOUNTAINS, DRINKING
—
x
$6
=
$
B.I
WATER PIPING/DRAIN—WASIE—VENT
INSTALLATION, ALTERATION OR REPAIR
X
$6
=
$
G
SEWAGE EJECTORS
GRINDER, SUMP PUMP
? *i
:ii{::
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER,PROOFER,
CARBONATOR, SWAMP COOLERS
x
$6
=
$
III
CROSS—CONNECTION DEVICES
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, SUMPS,
TANKS, BOILERS, & SPRINKLER SYSTEMS
X
$6
=
$
.
M#>'
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHBMICAL HOLDING TANK
MEDICAL GAS (per outlet/bottle station)
NITROUS, OXYGEN •
X
$6
=
$
,Q
MISCELLANEOUS FIXTURES
x
$6
=
$
NOTE: MINIMUM PERMIT FEE IS $35.00
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
$
SIGNATURE:
SPOKANE COUNTY DIVISION OF BUILDINGS
WEST 1026 BROADWAY AVENUE' SPOKANE, WA 99260 * (509) 456-3675