1996, 05-02 Permit App: 96003033 Plumbing ReversalPLUMBING PERMIT APPLICATION
co -30-53
PROJECT ADDRESS: 7 9 cz6 _ 5 lJ 1a 1-/ Cc --e
OWNER: (i,iiiJ �/mai
MAILING ADDRESS: 0/ /6) < - ��� /7 r/ S "P
(street)
CONTRACTOR:
MAILING ADDRESS: I rl 5 2 p
PHONE: DAYTIME CONTACT 9;;,,;) -S 79
(y-1g'Jif y��o�
city/state) (zip)
LICENSE: 40b�RJPgs(.,5 t
PHONE: Zr] . 9 O
carrP6 vi 9 C3 lam,
(zip)
(street)
(city/state)
PLUMBING FIXTURES
DESCRIPTION DETAIL
# OF
UNITS
MIND BY
COST
/UNIT
AQUAL$
AMOUNT
.BOA
TOILETS
WATER CLOSETS, BIDETS
x
$6
$
URINALS
x
$6
$
B04
TUBS
BATH, JACUZZI. SPA, GARDEN
x
$6
$
#Q5
SHOWERS (per trap)
BASE, STALL, ON—SITE BUILD
x
$6
$
SINKS
LAVS/BASINS, BAR, FLOOR KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X—RAY, FOOD (PREP/CULINARY/MEAT)
x
$6
$
DISHWASHER
x
$6
$
CLOTHES WASHER
x
86
$
B09
GARBAGE DISPOSAL/GRINDER
x
$6
$
WATER SOFTENER
x
$6
$
ELECTRIC HOT WATER TANKS
(NOTE: if ga:',stet tank, see:meehanial)
x
86
$
B
FLOOR DRAINS
AREA, CASE, COR, TRENCH, CONDENSATE
x
86
$
ROOF DRAINS/OVERFLOW DRAINS (ea.)
x
$6
$
Br
FOUNTAINS, DRINKING
x
$6
$
B16
WATER PIPING/DRAIN—WASTE—VENT/
PLUMBING REVERSALS
SEWAGE EJECTORS
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
GRINDER, SUMP PUMP
x
x
$6
$6
B17
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLERS
x
86
$
;18
CROSS—CONNECTION DEVICES
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, SUMPS,
TANKS, BOILERS, & SPRINKLER SYSTEMS
x
$6
$
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
86
$
NOTE: MINIMUM PERMIT FEE IS
SIGNATURE:
Al -/IJ
Subtotal
PLUS: PROCESSING FEE
$25.00
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.
.MAKE: CHECKS
'SPOKANE COUNTTPERMITCENTER.
3
r
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 address:
PROJECT INFORMATION
Dry Line
Sewer? (Y/N)
City:
Zip:
Parcel number(ifknown):
Owner's name:
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):
Z - P e 5+ Con4-irruc.-t;on
Business address:
13ro ad6/Gt..
City/State: S 0 oka R W
Zip: 9 c12-12- Phone: a I- q q 4l
State contractor license number:
Z gt✓ST c9) -7 r) Q i+
Utilities installers permit number:
INTERIOR PLUMBING ALTERATIONS?
Fill out the information in the table below if applica %e*
) circle one
Contractor (if different from above):
,oiner-I' J tr,VII Ac7i1
Business Address:
20 e . (moi
Phone: G22"1 • G O 84-3
City/State/Zip:
q rccrl a cYc 4
WA cgol,
FEE INFORMATION
Sewer Connection: Number of Buildings X (times) $SO (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:
novel/ow
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.