1994, 10-21 Permit App: 94010480 Plumbing Fixtures•
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.
PROTECT INFORMATION
Job address: /%
,3,e/. -7 ,4 -1,.. -pc r"),..-.1
Owner's name:
&(YJ-g-,-wie/1.--
Business address:
I'eD 8 c>dc 1L4-2 ,a2_
City/State:
City/State: ,5013c-). cu -N. P, ti/A
City:
Zip: 9'7')ii s
Zip:
Parcel number (if known):
Phone:
,
--‘2G
WILL THE PROPERTY OWNER BE PERFORMING THE SEWER CONNECTION
INSTALLATION?* Yes No
*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
Contractor (company name):
A-rms-1'Cpn3 cons-1'ruc--bion
State contractor license number:
A&.M.S1 L- 1.612 t.) 1
Business address:
I'eD 8 c>dc 1L4-2 ,a2_
Utilities installers permit number:
City/State: ,5013c-). cu -N. P, ti/A
Zip: gci214- Phone: q2. ,i3 - 055c1
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 buildin_, shop, garage etc., that will be connected to the sewer)
APPLICANT SIGNATURE:
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675
PLUMBING PERMIT A'Ps„ IQATION
PROJECT ADDRESS:
OWNER:
PHONE:
MAILING ADDRESS:
CONTRACTOR: _ b ,S Qi%1
MAILING ADDRESS: I I 5 �Q E.
(street)
(city/state)
(Zip)
(street)
LICENSE: 4D P J P p/) �- 8 1
PHONE: `Y
r acres \A 9 g e t 1,,
(city/state) (zip)
PLUMBING FIXTURES
DESCRIPTION DETAIL
# OF
UNITS
MUi n -
PLIED BY
COST
/UNIT
EQUALS
AMOUNT
B02
TOILETS
WATER CLOSETS. BIDETS
x
$6
B03
B04
URINALS
x
$6
$
TUBS
BATH, JACUZZI, SPA. GARDEN
x
$6
S
B05
SHOWERS (per trap)
BASE, STALL, ON—SITE BUILD
x
$6
B06
SINKS
IAVSBASINS. BAR. FLOOR KLTCHEN,
LAUNDRY, UTILITY, JANITOR PHOTO,
X—RAY, FOOD (PREP/CULINARY/MEAT)
x
$6
$
B07
DISHWASHER
x
$6
S
B08
CLOTHES WASHER
x
$6
$
B09
GARBAGE DISPOSAL/GRINDER
x
$6
$
1310
WATER SOFTENER
x
$6
$
B11
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank. see mechan ial)
x
$6
S
B12
FLOOR DRAINS
AREA, CASE, COIL, TRENCH. CONDENSATE
x
$6
B1.
B14
ROOF DRAINS/OVERFLOW DRAINS (ea.)
FOUNTAINS, DRINKING
x
x
$6
$6
$
$
B15
WATER PIPING/DRAIN—WASTE—VENT/
PLUMBING REVERSALS
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
x
$6
$
B16
B17
SEWAGE EJECTORS
GRINDER. SUMP PUMP
x
$6
$
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER. PROOFER.
CARBONA1DR, SWAMP COOLERS
x
$6
$
B18
CROSS—CONNECTION DEVICES
VACUUM BREAKER CHECK VALVE,
AND R.P.B.P.D. FOR VATS. SUMPS,
TANKS, BOILERS, & SPRINKLER SYSTEMS
x
$6
$
'81:9
INTERCEPTORS
GREASE TRAP, SAND TRAP.
CHEMICAL HOLDING TANK
x
$6
S
B20
MEDICAL GAS (per outlet/bottle station)
NITROUS. OXYGEN
x
$6
5
B2I
MISCELLANEOUS FIXTURES
x
$6
S
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE:
Spokane County Division of Buildings
1026 W. Broadway Avenue • Spokane, WA 99260
Tel. No. (509) 456-3675 • Fax No. (509) 456-4703 • TDD No. (509) 324-3166
WASTERVWMPERM.HND
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
PLEASE MAKE CHECK 'A iCABLE TO
SPOKANE COUNTY PERMITCENTER