HomeMy WebLinkAbout1996, 05-02 Permit App: 96003045 Plumbing Reversal PLUMBING PERMIT APPLICATION
PROJECT ADDRESS: 6/ ,-S', � i ,� _ lQ
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OWNER: PHONE:DAYTIME CONTACT
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MAILINGADDRESS: , / At-e2,719-2,c +( • `_-7 ) ' Z:6)65.
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(street) (city/state) (zip)
CONTRACTOR: (;,p7.,6-1,-v4(i,,i p rN0,4n 5 LICENSE:g ES'-1�P...1t 0 g z M T-
PHONE: 27.x- /6 SL/
MAILING ADDRESS: l ;t 4 i to A-L14, 4rrc nai its 1 I A i 61 016
(street) (city/state) (zip)
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PLUMBING FIXTURES #OF sawn- COST
DESCRIPTION I DETAIL UNITS PLUM sr /UNIT aoua.s AMOUNT
-.B02 TOILETS WATER CLOSETS,BIDETS x $6 = $
BO3 URINALS - x $6 = $
:B04 TUBS BATH,JACUZZI,SPA,GARDEN x $6 = $
SHOWERS(per trap) 0 STALL,ON-s1TE BUILD x $6 = $
`8.06 SINKS LAVS/BASINRR BAFLOOR,KITCHEN, x $6 = $
kBASE,LAUNDRY,UTILITY,JANITOR PHOTO,
• X-RAY,FOOD(PREP/CULINARY/MEAT)
B0DISHWASHER - x $6 ' = $
BOB CLOTHES WASHER - x $6 = $
B.i 9 GARBAGE DISPOSAL/GRINDER - x • $6 = $
B10 WATER SOFTENER - x $6 = $
:131I ELECTRIC HOT WATER TANKS (NOTE:if gas water tank see mechanical) x $6 = $
:n.12 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE x $6 = $
ELI ROOF DRAINS/OVERFLOW DRAINS(ea.) - x $6 = $
1114 FOUNTAINS,DRINKING - x $6 = $
SO WATER PIPING/DRAIN-WASTE-VENT/ n4 RATION,REPAIR / x $6 = S� e
>>>>PLUMBING REVERSALS w RE�SALS �-')
B16 SEWAGE EJECTORS GRINDER SUMP PUMP x $6 = $
B17 WATER USING DEVICES ICE AND/OR COFFEE MAKER x $6 = $,
HOSE BIB,STEAMER PROOFER,
CARBONATOR,SWAMP COOLERS
Bi$CROSS-CONNECTION DEVICES VACUUM BREAKER CHECK VALVE, x $6 = $
AND R.P.B.P.D.FOR:VATS SUMPS.
giiiiiii TANKS,BOILERS,&SPRINKLER SYSTEMS
B19INTERCEPTORS GREASE TRAP,SAND TRAP, x $6 = $
..f'>`2< CHEMICAL HOLDING TANK
1320 MEDICAL GAS(per outlet/bottle station) NITROUS,OXYGEN x $6 = $
B21 MISCELLANEOUS FIXTURES x $6 = $
NOTE: MINIMUMPERMIT FEE IS$35.00 Subtotal
PLUS: PROCESSING FEE $25.00
SIGNATURE:
s' 6 /Z-CZ,z.---- _-) TOTAL PERMIT FEE DUE
PLEASE MAKE CHECKS PAYABLE TO
Spokane County Division of Buildings SPOKANE COUNTY PERMITCENTER
1026 W.Broadway Avenue•Spokane,WA 99260
Tel.No.(509)456-3675 •Fax No.(509)324-3198•TDD No.(509)324-3166
Spokane County does not discriminate on the basis of disability in the admission to,or treatment or employment in.its programs or activities.
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SEWER CONNiECTION 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. Also note that sewer permits are valid for 12 months from the date of issuance. No
extensions will be granted.
PROJECT INFORMATION
Job address: Dry Line Owner's name:
Sewer? (Y/N) .
City: City/State:
Zip: Zip:
Parcel number(irknown): Phone:
First-time contractors or home-owners performing the installation must first contact the utilities department(in person
or via phone[456-3604J) before a permit can be issued
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Contractor(company name): State contractor license number:
Cous' Exccwct,+ion Coup �c- �.F1-4111
Business address: Utilities installers permit number:
1 IpLEO2 E V l WA'City/State: VP' (ILA rue_. WAB
Zip: GCi p 3'] Phone: q2A5 t-4-R
INTERIOR PLUMBING ALTERATIONS? (yes/no) circle one
Fill out the information in the table below if applicable**
Contractor (if different from above): Phone: G 22. • 11-1-1
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Business Add?ess: J City/State/Zip:
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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.
*Condos,townhouses, &2-3-and 4-plexes require I permit per address/stub.
*Multiple buildings(apartments, industrial complexes)require I permit per building. •
(For situations not covered here, call the County Utilities Division @ 456-3604)
APPLICANT SIGNATURE: Date:
In41111033
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260
PHONE: (509)456-3675 * FAX: (509) 324-3198 *TDD: (509) 324-3166
Spokane County does not discriminate on the basis of disability in the admission to,or treatment or employment in,its programs or activities.
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