1994, 11-08 Permit App: 94011185 Plumbing Fixtures PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER: . PHONE:
MAILING ADDRESS
/L,5
e YYY�"„/V_ (street) (city/state) (zip)
CONTRACTOR: LICENSE:
PHONE:
MAILING ADDRESS:
(street) (city/state) (zip)
PLUMBING FIXTURES # OF MULTI- COST
DESCRIPTION I DETAIL UNITS PLIED BY /UNIT EQUALS AMOUNT
B02 TOILETS WATER CLOSETS.BIDETS I I I x X $61 = $
B03 URINALS — $6 =— $
B04 TUBS BATH,JACUZZI,SPA,GARDEN X $6 = $
B05 SHOWERS(per trap) BASE,STALL,ON—SITE BUILD X $6 = $
B06 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN, x $6 = $
LAUNDRY,UTILITY,JAN FOR,PHOTO,
X—RAY,FOOD(PREPiCULINARY/MEAT)
$07 DISHWASHER — x $6 = $
BOB CLOTHES WASHER — x $6 = $
B09 GARBAGE DISPOSAUGRINDER — x $6 = $
BID WATER SOFTENER - x $6 = $
Bi 1 ELECTRIC HOT WATER TANKS (NOTE: if ps water tank,see mechanical) x $6 = $
B12 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6 = $
B13 ROOF DRAINS/OVERFLOW DRAINS(ea.) — x $6 = $
B1:4 FOUNTAINS,DRINKING • — x $6 = $
B15 WATER PIPING/DRAIN—WASTE—VENT/ INSTALLATIoN,AI reRATION,REPAIR x $6 = $
>>PLUMBING REVERSALS REVERSALS
B16 SEWAGE EJECTORS GRINDER,SUMP PUMP x $6 = $
13.37 WATER USING DEVICES ICE AND,OR COFFEE MAKER, x $6 = $ -
HOSE BIB,STEAMER,PROOFER,
CARBONAThR,SWAMP COOLERS
BIB CROSS—CONNECTION DEVICES VACUUM BREAKER CHECK VALVE, x $6 = $
AND R.P.B.P.D.FOR:VATS,SUMPS,
II TANKS,BOILERS,&SPRINKLER SYSTEMS
Bl91NTERCEPTORS GREASE TRAP,SAND TRAP, x $6 = $
CHEMICAL HOLDING TANK
P2d MEDICAL GAS(per outlet/bottle station) NITROUS,OXYGEN X $6 = $
B2'1 MISCELLANEOUS FIXTURES x $6 = $
NOTE: MINIS RMI , FEE IS$35.00 Subtotal
_ PLUS: PROCESSING FEE $25.00
e.:,-/: " �.__
SIGNATURE: � TOTAL PERMIT FEE DUE $ �'�
PLEASE:MAKE CIiEGKS PAYABI;E TO
Spokane County Division of Buildings SPOKANE COUNTY PERMIT CENTER:
1026 W. Broadway Avenue *Spokane,WA 99260
rel.No.(509)456-3675 * Fax No.(509)456-4703 •TDD No. (509)324-3166
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SEWER CONNECTION PERMIT
APPLICATION FORM
PLEASE NOTE: This application form must be filled out accurately and in its entirety, . d signed,
or a permit will not be issued.
PROJECT INFORMATION
Job address: Owner's name:
5 4 Z D Cti,-ti ,,-- 7/ 6/2,Pk,
City: A-- u City/State:
Zip: 9c Z i Z Zip:
Parcel number (if known): 1 Phone:
WILL THE PROPERTY OWNER BE PERFORMING THE SEWS' ONNECTION
INSTALLATION?* Yes No
*If property owner is installing the sewer connection, they must first contact the UTILITIE: DEPARTMENT for construction
requirements before the permit is issued.
CONTRACTOR INFO ION
Contractor (company name): tate contractor license number:
Artgray S A c_.-i-i viz. A L V1/AV A 4- 1O l P 5
Business address: Utilities installers permit number:
Po aO)L ji--[ I5Ce,2,
City/State: •SPp,Kr \e_ vVA
Zip: 9 G ZI 4 Phone: co 2 - B 5 on
INTERIOR PLUMBING 2tTERATIONS (if applicable)**
Contractor (if differPp_t from nborqt� Phone•
f� ` I
Business Addres � City/State/Zip:
//J J I
** For plumbing reversal fee i formation, see reverse side of this form.
F INFORMATION = S
Sewer Connection: Number of Buildi. 1
gS / X (times) $S O (per bldg $ /�
TOTAL FEE
(One permit required for each separate building, shop,garage, e that will be connected to the sewer)
APPLICANT SIGNATURE: j' f - - Date: /i- /- 9 V
wosacivass
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675