1994, 08-15 Permit App: 94007906 and 907 Plumbing FixturesSEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND
SIGNED OR PERMIT WILL NOT BE ISSUED.
j� (IF KNOWN) qt4 --Ili
I
JOB ADDRESS : CQ I IA S S. \C_ V\`f.,R.C_X PARCEL NUMBER:
CITY: Fc5 P;t\)VL 1 STATE: 4) pit• ZIP CODE:
OWNER NAME : 1\1\i\ �- \A_ IJ 12).'\ �7 ADDRESS :
CITY : S p ` CAc,P) STATE: `� ZIP CODE:
U
PHONE NUMBER: CI a t - (p'n
1.0 4 -
PROPERTY
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES
EIRCLE 0
qqb
c qoJ-
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR:
CITY:
PHONE NUMBER:
STATE CONTRACTORS LICENSE NUMBER:
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? NO (CIRCLE ONE)
INTERIOR ALTERATION BY: 3tk)4/
ADDRESS:
STATE:
ZIP CODE:
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 = 50•O Q
DUE INTERIOR PLUMBING ALTERATIONS:# OF BUILDINGS
PERM) FEE 35.00 $
APPLICANT
SIGNATURE:
-e/Lt -1/1/1 _12
DATE: ovs-T: 94
`9. =
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675 T �,--
PLUMBING PERMI I APi'LICATION
PROJECT ADDRESS:
OWNER: {�
MAILING ADDRESS: `L S . 6 f �C
(street) (city/state)
PHONE: 9ai -- 6,90 I
CONTRACTOR:
. Cotisf:
(Zip)
LICENSE:
MAILING ADDRESS: k 3 g l ( E . \T—k
(street)
PHONE: ct a7 - lJ'7(0 0
WN'� LON- Qq'�[ (e)
(city/state) (zip)
TcI. No. (509) 456-3675 • Fax No. (509) 456-4703 • TDD No. (509) 324-3166
WASTER\ PLUMP CR M. HUD
PLUMBING FIXTURES
DESCRIPTION DETAIL
# OF
UNITS
MULTI-
►LBO DY
COST
/UNIT
SOMALI
AMOUNT
1302
TOILETS
WATER CLOSETS, BIDETS
C
x
$6
=
$ L , o 0
B03
URINALS
-
x
$6
=
$
B04
TUBS
BATH, JACUZZI, SPA, GARDEN
x
$6
=
$
B05
SHOWERS (per trap)
BASE, STALL,ON—SITE BUIID
(
x
$6
=
$,(0 .0 0
1306
SINKS
LAVS/BASINS, BAR, FLOOR KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X—RAY, FOOD (PREP/CULINARY/MEAT)
x
$6
=
$
0 0
1307
DISHWASHER
-
x
$6
=
$
1308
CLOTHES WASHER
-
x
$6
=
$
1309
GARBAGE DISPOSAL/GRINDER
-
x
$6
=
$
B10
WATER SOFTENER
-
x
$6
=
$
Bil
ELECTRIC HOT WATER TANKS
(NOTE: if Ips water tank, 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/
PLUMBING REVERSALS
INSTALLATION. ALTERATION,REPAIR,
REVERSALS
/
x
$6
=
$
C . o Q
B16
SEWAGE EJECTORS
GRINDER, SUMP PUMP
x
$6
=
$
B17
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLERS
x
$6
=
$
B18
CROSS—CONNECTION DEVICES
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.PD. FOR: VATS SUMPS,
TANKS BOILERS & SPRINKLER SYSTEMS
x
56
=
$
B19
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: MINIMUMPERMIT FEE IS $35.00
SIGNATURE:1...st .4 L ' _ Ai —.0:41 �_
Subtotal
Al . D CI
PLUS: PROCESSING FEE —
TOTAL PERMIT FEE DUE
$ ,On
County Division of Buildings
W. Broadway Avenue • Spokane, WA 99260
PLEASE MAKE CHECKS PAYABLE TO:
SPOKANE COUNTY PERMIT CENTER
TcI. No. (509) 456-3675 • Fax No. (509) 456-4703 • TDD No. (509) 324-3166
WASTER\ PLUMP CR M. HUD