1995, 02-13 Permit App: 95000741 Plumbing FixturesPLUMBING P RR MJT APPLICATION
PROJECT ADDRESS: 3 5/ �(( y( doze)
OWNER:V-17)"
MAILING ADDRESS: j73-
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PHONE: c.:1)
�C1U
�1 Z� - L _ L)A-
(street)
MAILING ADDRESS: f 7 S3 (� L (p
(ci y/state) (zip)
LICENSE: th
PHONE: 4 %- �n
ti
(street) (city/state) (zip)
Tcl. No. (509) 456-3675 * Fax No. (509) 456-4703 * TDD No. (509) 324-3166
\MASTE R \PLU M P FR M I I N D
PLUMBING FIXTURES
DESCRIPTION DETAIL
# OF
UNITS
MULTI-
PLUM BY
COST
/UNIT
EQUALS
AMOUNT
1302
TOILETS
WATER CLOSETS, BIDETS
1
X
$6
=
$ l,(3
B03
URINALS
—
x
$6
=
$
1304
TUBS
BATH, JACUZZI, SPA, GARDEN
X
$6
=
$
1305
SHOWERS (per trap)
BASE, STALL, ON—SITE BUILD
I
X
$6
=
$ LQ
B06
SINKS
IAVSBASINS,BAR, FLOOR, KTTCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X—RAY, FOOD (PREP/CULINARY/MEAT)
j
I
x
$6
=
$
/ „
((/
B07
DISHWASHER
—
x
$6
=
$
1308
CLOTHES WASHER
—
x
$6
=
$
1309
GARBAGE DISPOSAL/GRINDER
—
x
$6
=
$
1310
WATER SOI' 1'ENER
—
x
$6
=
$
B11
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank, see mechanical)
X
$6
=
$
B12
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
x
$6
=
$
1313
ROOF DRAINS/OVERFLOW DRAINS (ea.)
—
x
$6
=
$
1314
FOUNTAINS, DRINKING
—
x
$6
=
$
1315
WATER PIPING/DRAIN—WASTE—VENT/
PLUMBING REVERSALS
INSTALLATION. ALTERATION. REPAIR,
REVERSALS
x
$6
=
$
1316
SEWAGE EJECTORS
GRINDER, SUMP PUMP
X
$6
=
$
1317
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLERS
x
$6
=
$
1318
CROSS—CONNECTION DEVICES
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS SUMPS,
TANKS, BOILERS, & SPRINKLER SYSTEMS
x
$6
=
$
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
=
$
NOTE: MINIMUM PERMIT
SIGNATURE: /j —....di_
dPLEASE
Spokane County Division of Buildings
1n76 w Rrradwav Avenue * Spokane. WA 99260
FEE IS $35.00 .
/
13
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
S tp
MAKE CHECKS PAYABLE TO.
SPOKANECOUNTY PERMIT CENTER
Tcl. No. (509) 456-3675 * Fax No. (509) 456-4703 * TDD No. (509) 324-3166
\MASTE R \PLU M P FR M I I N D
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. 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
Sewer? (Y/N)
Owner's name:
City:
City/State:
Zip:
Zip:
Parcel number (if known):
Phone:
First-time contractors or home -owners performing the installation must first contact the utilities department (in
person or via phone [456-3604]) before a permit can be issued.
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Contractor (company name):
State contractor license number:
Business address:
Utilities installers permit number:
City/State:
Zip:
Phone:
INTERIOR PLUMBING ALTERATIONS Of 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.
* Condos, townhouses, & 2- 3- and 4-plexes require 1 permit per address/stub.
* Multiple buildings (apartments, industrial complexes) require 1 permit per building.
(For situations not covered here, call the County Utilities Division @ 456-3604)
APPLICANT SIGNATURE:
Date:
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675