1995, 04-19 Permit App: 95002471 Plumbing FixturesSEWER 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:
Owner's name:
City:
City/State:
Zip:
Zip:
Parcel number (if known):
Phone:
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):
4-ern3-1-(p n cons- - r u c --h oin
State contractor license number:
Ag M .s -f C- - 1.612. t.) I.
3
Business address:
-().(D Pi plc 1142_,`32.
Utilities installers permit number:
City/State: ,SPc C'\r, WA
Zip: cl ci 2_114 Phone: q 2 S- 05 5G
INTERIOR PLUMBING ALTERATIONS (fapplicable)**
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:
Date:
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675
PLUMBING PERMIT APPLICATION
-
PROJECT ADDRESS:
OWNER:
IN
PHONE:
MAILING ADDRESS. c, qQ LC -
CONTRACTOR: _RC)b �(-* OV S Or\
MAILING ADDRESS: 1 I
street)
(city/state)
(zip)
(street)
LICENSE: 4,D A e J P Y' /�' 6 g 1
PHONE: Y' f
Are r_nc is WA 9 Gt0t 1,
(city/state) (zip)
PLUMBING FIXTURES
DESCRIPTION DETAIL
# OF
UNITS
'uLTI-
PLIED BY
COST
/UNIT
EQUALS
B02
B03
TOILETS
WATER CLOSETS, BIDETS
x
$6
AMOUNT
URINALS
x
S6
S
pit
BO5
1306
TUBS
BATH, JACUZZI, SPA, GARDEN
x
$6
S
SHOWERS (per trap)
BASE, STALL, ON—SITE BUILD
x
$6
S
SINKS
LAVS/BASINS, BAR. FLOOR. KITCHEN.
LAUNDRY, UTILITY. JANITOR PHOTO,
X—RAY, FOOD (PREP/CULINARY/MEAT)
x
$6
S
E0.7
DISHWASHER
x
$6
S
B0:8
CLOTHES WASHER
x
$6
S
1409
GARBAGE DISPOSAUGRINDER
x
$6
S
WATER SOFTENER
x
$6
S
;B11
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank, see mechanic:4)
x
$6
S
B12
3
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
x
$6
S
ROOF DRAINS/OVERFLOW DRAINS (ea.)
x
$6
S
B1.4
FOUNTAINS, DRINKING
x
$6
S
WATER PIPING/DRAIN—WASTE—VENT/
PLUMBING REVERSALS
INSTALLATION. ALTERATION, REPAIR
REVERSALS
x
$6
S
:114
A7
SEWAGE EJECTORS
GRINDER SUMP PUMP
x
$6
S
WATER USING DEVICES
ICE AND/OR COFFEE MAKER
HOSE BIB. STEAMER. PROOFER.
CARBONAIOR,SWAMP COOLERS
x
$6
S
B18
CROSS—CONNECTION DEVICES
VACUUM BREAKER CHECK VALVE,
AND R.P.B.P.D. FOR: VATS SUMPS.
TANKS. BOILERS, & SPRINKLER SYSTEMS
x
S6
S
B19
INTERCEPTORS
GREASE TRAP, SAND TRAP.
CHEMICAL HOLDING TANK
x
$6
S
B20
MEDICAL GAS (per outlet/bottle station)
NITROUS, OXYGEN
x
$6
$
B21
MISCELLANEOUS FIXTURES
x
S6
S
NOTE: MINIMUMPERMIT 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
wArnimmuummuavo
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE