1994, 10-07 Permit App: 94009943 Sewer-ciTO
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'
eco i
name:
CUL-) /4--//�
/6o 66 6 /" / JL -C it ( r
City: /%A d 2
City/State:
Zip:
4) Q /�7.1S/ (,t/C(
Zip: jq() 3-2
Q9-()7
Zip:
Parcel number (if known):
Phone:
WILL THE PROPERTY OWNER BE PERFORMING THE SEWER CONNECTION
INSTALLATION?* Yes iNo
*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
Co actor (company
nam/e,)
State contractor license number:
1
W/Let.(r-ti—
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:
saves
Date:
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675
-PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER:
PHONE:
MAILING ADDRESS:
(street)
CONTRACTOR:
(city/state)
(zip)
LICENSE:
PHONE:
MAILING ADDRESS:
(street)
(city/state)
PLUMBING FIXTURES
DESCRIPTION DETAIL
(zip)
B02
B03
TOILETS
WATER CLOSETS. BIDETS
# OF
UNITS
MULTI
PUBD BY
x
COST
/UNIT
$6
BQUALs
AMOUNT
S
URINALS
x
$6
$
TUBS
BATH, JACUZZI, SPA, GARDEN
x
$6
S
B05
1306
SHOWERS (per trap)
BASE, STALL, ON—SrrE BUILD
x
$6
S
SINKS
1307
1308
1309
DISHWASHER
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X—RAY, FOOD (PREPICULINARY/MEAT)
x
$6
S
x
S6
S
CLOTHES WASHER
x
$6
S
GARBAGE DISPOSAL/GRINDER
x
$6
S
310
B1!1
WATER SOFTENER
x
S6
S
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
•
B14
B15
ROOF DRAINS/OVERFLOW DRAINS (ea.)
x
$6
S
FOUNTAINS, DRINKING
x
$6
$
WATER PIPING/DRAIN—WASTE—VENT/
PLUMBING REVERSALS
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
x
S6
S
B16
B17
SEWAGE EJECTORS
GRINDER, SUMP PUMP
x
$6
S
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLERS
x
$6
S
1318
CROSS—CONNECTION DEVICES
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, SUMPS,
TANKS, BOILERS, & SPRINKLER SYSTEMS
x
$6
S
B1:9
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
x
$6
$
1320
MEDICAL GAS (per outlet/bottle station)
NITROUS, OXYGEN
x
$6
S
B21
MISCELLANEOUS FIXTURES
x
$6
S
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE:
>pokane County Division of Buildings
1026 W. Broadway Avenue • Spokane, WA 99260
fel. No. (509) 456-3675 * Fax No. (509) 456-4703 • TDD No. (509) 324-3166
RASTERVLU/A aR LHND
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
PLEASE<MAKE CHECKS PA
SPOKANE COUNTY PERMITCENTEI