1994, 08-02 Permit App: 94007268 Plumbing Reversal, Fixtures 1„0/
SEWER CONNECTION PERMIT APPLICATION FORM z 7 2 4.7
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND
SIGNED OR PERMIT WILL NOT BE ISSUED.
!/ ,�}� -�- , (IF KNOWN) C� ��
JOB ADDRESS : t�l 7 S, U/g/J / (�/4- /' PARCEL NUMBER: 4 7 2.
CITY: e ;t) /V , STATE: vC4 ZIP CODE:
OWNER NAME: /,7/ 4-, 4,0i Lf ADDRESS:
CITY: y)47/(7;44/e:, STATE: l� ZIP CODE:
PHONE NUMBER: 57R174- ?/25-0
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: n ADDRESS : I38 I l,v, e7 • I2 r te.
CITY: n STATE: 4A- ZIP CODE: 9 2l (.
PHONE NUMBER: 2.1 - cYJ k2
STATE CONTRACTORS LICENSE NUMBER: �t L.1 G G D - - 1 95 I M (p
UTILITIES INSTALLERS PERMIT, NUMBER:
INTERIOR PLUMBING ALTERATIONS? 4111100 NO (CIRCLE ONE)
INTERIOR ALTERATION BY: , S d.
ADDRESS : PHONE NUMBER:
CITY : STATE: ZIP CODE:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION • # OF BUILDINGS / X 50 . 00 = Oo
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS / X 35. 00 = .! 1
TOTAL PERMIT FEE DUE $
APPLICANTr /
SIGNATURE '/ " DATE:
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS: / Si 7
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OWNER: I �/- A-114 Gt r= PHONE: ,,,,? `i ` ?(,) S 0
MAILING ADDRESS:
(street) (city/statc) (zip)
CONTRACTOR: 4, k ,C , Ct LICENSE: —_
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MAILING ADDRESS: /3 , / q�h „Sr 0A K) J J r � DJ 6j
(street) (city/state) (lip)
PLUMBING-FIXTURES # OF win- COST-I
DESCRIPTION I DETAIL UNITS nap BY IUN tvAuLAMOUN'J
)0TOILETS WATER CLOSETS.BIDETS / x S6 = IS , .O
B.P URINALS - x S6 = S ,
BV4 TUBS BATH,JACUZZI,SPA,GARDEN x $6 = $
$()S SHOWERS(per trap) BASE,STALL,ON-SITE BUILD ( x S6 = $ & . OC)
B06 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN, x $6 = $
LAUNDRY,UTILITY,JANITOR,PHOTO, f , O
X-RAY,FOOD(PREP/CULINARY/MEAT) (
B DISHWASHER - x $6 = $
TN CLOTHES WASHER - x $6 = $
BO GARBAGE DISPOSAL/GRINDER - x $6 = $
Bit}WATER SOFTENER - x $6 = $
701, TRI
ELECC HOT WATER TANKS (NOTE: it aa:water tank,see mechanical) x $6 = $
on FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE - x $6 = $
WO ROOF DRAINS/OVERFLOW DRAINS(ea.) - x $6 = $
)314 FOUNTAINS,DRINKING - x $6 = $
B15 WATER PIPING/DRAIN-WASTE-VENT INSTALLATION,ALTERATION OR REPAIR x $6 = $
B16 SEWAGE EJECTORS GRINDER,SUMP PUMP x $6 = $
..,:::::::,,,
OW WATER USING DEVICES ICE AND/OR COFFEE MAKER, x $6 = $
111
HOSE BIB,STEAMER,PROOFER,
CARBONATOR.SWAMP COOLERS
B18 CROSS-CONNECTION DEVICES VACUUM BREAKER,CHECK VALVE, x $6 = $
AND R.P.B.P.D.FOR:VATS,SUMPS,
TANKS,BOILERS,&SPRINKLER SYSTEMS
Bj9 INTERCEPTORS GREASE TRAP,SAND TRAP. x $6 = $
II CHEMICAL HOLDING TANK
1120,MEDICAL GAS(per outlet/bottle station) NITROUS,OXYGEN x $6 = $
B xMISCELIANEOUSFD TURES / x $6 = $ 6 . D 0
Subtotal 01-/s00
NOTE: MINIMUM PERMIT FEE IS $35.00 PLUS: PROCESSING FEE $25.00
TOTAL PERMIT FEE DUE $619, DO
SIGNATURE:
SPOKANE COUNTY DIVISION OF BUILDINGS
WEST 1026 BROADWAY AVENUE*SPOKANE,WA 99260*(509)456-3675
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