1994, 10-28 Permit App: 94010805 SewerSEWER CONNECTION PERMIT 615 ' U 1
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 mote that sewer permits are valid for 12 months from the date
of issuance. No extensions will be granted.
PROJECT INFORMATION
Job address:
2 w1,2 s`��
State contractor license number:
Business address:
9 '/ 3 otg' ,44 -4A -y 40
Dry Line
Sewer? 9N)
Owner's name:
a �i
/0/Q.u{/
.
City: an, atua
(�
AS
City/State: ,.>�L
C
/v.
,
Zip:
Zip:
Parcel number (if known):
Phone:
l (
First-time contractors or home -owners performing the installation must first contact the utiities department in
person or via phone [456-3604]) before a permit can he issued.
Name of Utilities Department person contacted:
CONTRACTOR INFORMATION
Contractor (comp y name):
/3 C L ar.4� 7
State contractor license number:
Business address:
9 '/ 3 otg' ,44 -4A -y 40
Utilities installers permit number:
City/State: 1k
Zip: e7 o _n Phone: 9a7 -t 4e 3 9
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 building, slap, garage, etc., that will be connected to the sewer.
* Condos, townhouses, & 2- 3- and 4 -pier 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:
getd
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675
Date: /e) —2S 94'
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER:
PHONE:
MAILING ADDRESS:
CONTRACTOR:
(street) (city/state)
(zip)
LICENSE:
PHONE:
MAILING ADDRESS:
(street)
(city/state)
(zip)
Tel. No. (509) 456-3675 • Fax No. (509) 456-4703 • TDD No. (509) 324-3166
VMSTERV W MPERKIIND
PLUMBING FIXTURES
DESCRIPTION .DETAIL
# OF
UNITS
wtn-
PLIBDBY
COST
/UNIT
.puns
AMOUNT
B02
TOILETS
WATER CLOSETS, BIDETS
x
$6
=
$
>BD3
URINALS
—
x
$6
=
$
1304
TUBS
BATH,JACUZZZ SPA, GARDEN
X
$6
=
$
:BQ5
SHOWERS (per trap)
BASE, STALL, ON—SITE BUILD
x
$6
=
$
6
SINKS
IAVSBASAJS. BAR, FLOORxrrcuEN,
LAUNDRY, UTILITY, JANITOR PHOTO,
X—RAY, FOOD (PREP/CtJLINARY/MEAT)
X
$6
=
$
B(i3
DISHWASHER
—
x
$6
=
$
B08
CLOTHES WASHER
—
x .
$6
=
$
1309
GARBAGE DISPOSAUGRINDER
—
x
$6
=
$
i(}
WATER SOFTENER
—
X
$6
=
$
Bit
ELECTRIC HOT WATER TANKS
(NOTE: Bps water tank, see mechanical)
x
$6
=
$
B;2
FLOOR DRAINS
AREA, CASE, COB„ TRENCH, CONDENSATE
x
$6
=
$
WtA
ROOF DRAINS/OVERFLOW DRAINS (ea.)
—
x
$6
=
$
D1:4
FOUNTAINS, DRINKING
—
x
$6
=
$
rns
Srsfi4:
WATER PIPING/DRAIN—WASTE—VENT/
PLUMBING REVERSALS
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
x
$6
=
$
-1316
SEWAGE EJECTORS
GRINDER SUMP PUMP
x
$6
=
$
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMCRPROOFER,
CARBONA7OR, SWAMP COOLERS
x
$6
=
$
'B.I$
CROSS—CONNECTION DEVICES
VACUUMBREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS SUMPS.
TANKS BOILERS. & SPRINKLER SYSTEMS
x
$6
=
$
$I9
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6
=
$
1320
MEDICAL GAS (per outlet/bottle station)
NITROUS OXYGEN
X
$6
=
$
B21
MISCELLANEOUS FIXTURES
x
$6
=
$
Spokane
1026
NOTE: MINIAIUMPERMIT
SIGNATURE:
FEE IS$35.00
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
$
County Division of Buildings
W. Broadway Avenue • Spokane, WA 99260
PLUASEMA I3CIIECSS'Pt YABLETO'
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S f KAri . COTJNTY PERMFT CENTER<:
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Tel. No. (509) 456-3675 • Fax No. (509) 456-4703 • TDD No. (509) 324-3166
VMSTERV W MPERKIIND