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1994, 09-06 Permit App: 94008612 Sewer
SEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCU1ATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT BE ISSUED. (IF KNOWN) JOB ADDRESS: �' S, 090 ( ()`P I�S(' y PARCEL NUMBER: CITY: k Q. STATE: 721' ZIP 'CODE: 99366 OWNER NAME: ID r4OS hO I171 ADDRESS: 6949 c/ (litiototriy CITY:aj0© kAzikA STATE: u) /9 ZIP CODE: PHONE NUMBER: q D6 - PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO (CIRCLE • - *IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED. CONTRACTOR: Z-- .122C254- C.o f15A-(tA r-iOJ1 ADDRESS: 176 ( (.> . $r(--)0 A-We CITY: c6,,10(n 0l1C- STATE: VJA ZIP CODE: RQ 21 PHONE NUMBER: R Q I - q,I LIC nn STATE CONTRACTORS LICENSE NUMBER: Z e, ,S T"G- 0 11 -RH UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? (/;rES /) NO (CIRCLE ONE) INTERIOR ALTERATION BY: 6 `e .,eP' /� erOdda.)(1/ADDRESS : �f'��vs �5��(r � PHONE NUMBER: 81 CITY : STATE: (i ) ZIP CODE: 99c7:2-1? *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL BE CONNECTED TO THE SEWER. TOTALSEWER CONNECTION * ft OF BUILDINGS / X 50. 00 = . ifa INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS / X 35. 00 = Jr APPLICANT ///1 _7/ SIGNATURE: / / / DATE: SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675 XL.l.J lt'11J/1`I v .. .....a.A....�.... �.� .. ..._...�__.......-. — _ PROJECT ADDRESS: 6 C/ 6_ (I it / !/ r / L/V OWNER: A h J s/ A ,_C b 0 r.- /2 PHONE: q - �y . i /L MAILING ADDRESS: / .. al 6 , ,M-_„ 2 - (street) (ct state) (zip) CONTRACTOR:c..; —6Q ,LCO---21 J . LICENSE: es_filil 77/u PHONE: ,)ci / - 9 MAILING ADDRESS: L7 ?/(' r )6,-,„,,,0,4-30 i - Li//3_ /9�/,- (street) / (city/state) (zip) PLUMBING FIXTURES #OF MULTI- COST DESCRIPTION 1 DETAIL UNITS rueoer /UNIT PQUAU AMOUNT 1362 TOILE rs WATER CLOSETS,BIDETS I X $6 = $ BO?URINALS - x S6 = $ B04 TUBS BATH.JACUZZI.SPA,GARDEN x S6 = S I B05 SHOWERS(per trap) BASE,STALL,ON—SITE BUILD x $6 n iS B06 SINKS LAYS/BASINS.BAR,FLOOR.KrrCHE!N. X S6 e S LAUNDRY.UTILITY.JANITOR.PHOTO. X—RAY,FOOD(PREP/CUL ARY/MEAT) __ —i B07 DISHWASHER - x S6, = IS 1308 CLOTHES WASHER - x S6 = S B .WO GARBAGE DISPOSAL/GRINDER - x S6 = S BIO WATER SOFTENER - x S6 = $ al ELECTRIC HOT WATER TANKS (NOTE: If gas water tank.see mechanical) x $6 = $ 8.x,2 FLOOR DRAINS AREA,CASE.COIL,TRENCH.CONDENSATE x $6 = $ W.ROOF DRAINS/OVERFLOW DRAINS(ea.) — x $6 = $ B:14 FOUNTAINS,DRINKING x $6 = $ HU WATER PIPING/DRAIN—WAS IE—VENT INSTALLATION, TERATION R REPAIR x $6 = $ B16 SEWAGE EJECTORS GRINDER,SUMP PUMP x $6 = $ BO WATER USING DEVIC'FS ICE AND/OR COFFEE MAKER, x $6 = $ HOSE BIB,STEAMER,TROOPER, CARBONATOR,SWAMP COOLERS BIS CROSS—CONNECTION DEVICES VACUUM BREAKER,CHECK VALVE, x $6 - $ AND R.P.B.P.D.FOR:VATS,SUMPS, E£ii> TANKS,BOILERS,&SPRINKLER SYSTEMS Bi;?INTERCEPTORS GREASE TRAP,SAND TRAP, CHEMICAL HOLDING TANK Q MEDICAL GAS(per outlet/bottle station) NITROUS.OXYGEN X $6 = $ i i MISCELLANEOUS FIxTURES x $6 = $ Subtotal NOTE: MINIMUM PERMIT FEE IS$35.00 PLUS: PROCESSING FEE $25.00 TOTAL PERMIT FEE DUE $ 3,5-266 SIGNATURE: SPOKANE COUNTY DIVISION OF BUILDINGS WEST 1026 BROADWAY AVENUE•SPOKANE,WA 99260• (509)456-3675 1MMTF3t\PLt1M stmAND