1995, 10-27 Permit App: 95008945 Plumbing FixturesOrniatiIIonIII f eI� � "�IlI.t1Ri�lljIIlj!I!!Ni�
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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.
Job addre
lea r
City:
Zip:
PROJECT INFORMATION
Dry Line
Sewer? (Y/1
Parcel number(ifknown):
Owner's name:
`17/(/>am
City/State:
Zip:
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):
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Business address: _ `J
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City/State:
Zip: Z� Phone: �{
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State contractor license number:
AuPs M STG j 9 2 N
Utilities installers permit number:
INTERIOR PLUMBING ALTERATIONS?
Fill out the information in the table below if appli
**
0) circle one
Contractor (if different from above):
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Business Address:
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Phone: ct2`7 - cl'a 4�`R
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 eachseparate 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 1 permit per building.
(For situations not cover, ' here, call the County Utilities Division @4S6-3604)
geoolociaa
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260
PHONE: (509) 456-3675 * FAX: (509) 324-3198 * TDD: (509) 324-3166
APPLICANT SIGNATURE:
Date: /'
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities.
tis c\M.,. .war.,*
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER:
PHONE: DAYTIME CONTACT
MAILING ADDRESS:
CONTRACTOR: Acjnel-.1- JE -)\an
MAILING ADDRESS: I - ! 52.0 T (o-14-%
(street)
(street)
(city/state)
(zip)
LICENSEt e, \ P q5 ( S , )
PHONE: Cf Zrj — cI D R a
GIP Pzniir res 1A/A ) b
(city/state) (zip)
PLUMBING FIXTURES
DESCRIPTION DETAIL
# OF
UNITS
twan-
pulo BY
COST
/UNIT
PQUAL$
B02
TOILETS
WATER CLOSETS, BIDETS
x
$6
AMOUNT
URINALS
x
$6
$
TUBS
SHOWERS (per trap)
SINKS
BATH, JACUZZI, SPA, GARDEN
BASE, STALL, ON—SITE BUILD
LAVSIBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR. PHOTO,
X—RAY, FOOD (PREP/CULINARY/MEAT)
x
x
x
$6
$6
$6
$
DISHWASHER •
x•
$6
$
CLOTHES WASHER
x
$6
$
GARBAGE DISPOSAUGRINDER
x
$6
$
)10
011.
WATER SOFTENER
x
$6
$
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank, see mechanical) •
x
$6
$
BI2
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
x
$6
$
BI .
ROOF DRAINS/OVERFLOW DRAINS (ea.)
x
$6
$
FOUNTAINS, DRINKING
x
$6
$
WATER PIPING/DRAIN—WASTE—VENT/
PLUMBING REVERSALS
INSTAL4.ATION, ALTERATION, REPAIR
REVERSALS
x
$6
$
SEWAGE EJECTORS
GRINDER SUMP PUMP
x
$6
$
WATER USING DEVICES
ICE AND/OR COFFEE MAKER
HOSE BIB, STEAMER PROOFS ,
CARBONATDR,SWAMP COOLERS
x
$6
$
:B18
CROSS—CONNECTION DEVICES
VACUUM BREAKER CHECK VALVE,
AND R.P.BPD. FOR: VATS, SUMPS,
TANKS, BOILERS, & SPRINKLER SYSTEMS
x
$6
$
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
x
$6
$
MEDICAL GAS (per outlet/bottle station)
NITROUS, OXYGEN
x
$6
$
B21
MISCELLANEOUS FIXTURES
x
$6
$
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE:
Subtotal
PLUS: PROCESSING FEE
$2$.00
TOTAL PERMIT FEE DUE
$
Spokane County Division of Buildings
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.
1!2695 W•.,lols p,nYd
'LASEMAKE: CHECKS PAYABLE TO
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SPOKANE`COUNTY PERMIT CENTER