1994, 10-17 Permit App: 94010382 Sewer . qt/S-. f/ 63
SEWER CONNECTION PERMIT qct-/O 3$Z
APPLICATION FORM c141- 10163
PLEASE NOTE: This application form must be filled out accurately and in its entirety, and signed,
or a permit will not be issued.
PROJECT 00‹. Pee-�1
INFORMATION LAI
Job address: OwAer's name:
a\ s . (no Att)Ap C"/ L50 /0
City: ,Spo f� City/State:Sp 004
Zip: Zip:
Parcel number (if known): Phone: 9 ag- , U X
wq -SOI
_ WILL THE PROPERTY OWNER BE PERFORMING THE SEWER CONNECTION
INSTALLATION?* Yes
`If property owner is installing the sewer connection, they must first contact the UTILITIES DEPARTMENT for construction
requirements before the permit is issued.
CONTRACTOR INFORMATION
Contractor (company name): State contractor license number:
LC Conskr u Aki ovn 1 LGC O - '101 M 6
Business address: Utilities installers permit number:
13 93 I (o E . 12-K+ Ave_
City/State: py4n v
g /A
Zip: q GI 2.( (op Phone: C42_1 - ( �6,0
INTERIOR PLUMBING ALTERATIONS (if applicable)**
Cont actor (if different from above): Phone:
(
Business Address: ( City/State/Zip:
** For plumbing reversal fee information, see reverse side of this form.
FEE INFO TION
Sewer Connection: Number of Buildings X (times) $50 (per bldg) _ $ ?C?,
TOTAL FEE
(One permit required for each separate building, shop,garage, etc., that will be connected to the sewer)
APPLICANT SIGNATURE: • ,Date: /O -17-9
.0.1040/043
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER: PHONE:
MAILING ADDRESS:
(street) (city/state) (zip)
CONTRACTOR: LICENSE:
PHONE:
MAILING ADDRESS:
(street) (city/state) (zip)
PLUMBING FIXTURES # OF MULTI- COST
DESCRIPTION I DETAIL UNITS PLIED BY NIT B.uwu AMOUNT
B02 TOILETS WATER CLOSETS,BIDETS
BO:i URINALS — x $6 = $
�B04TUBS BATH,JACUZZI,SPA,GARDEN X $6 = $
Bb.5 SHOWERS(per trap) BASE,STALL,ON—SITE BUILD x $6 = $
,B0.6 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN, X $6 = $
LAUNDRY,UTILITY,JANITOR,PHOTO,
X—RAY,FOOD(PREP/CULINARY/MEAT) (./ --
T07 DISHWASHER — x $6 = $
B08 CLOTHES WASHER — x $6 = $
...0:, x $6 = $
(BL' 9 GARBAGE DISPOSAL/GRINDER —
1310 WATER SOFTENER — x $6 = $
BII ELECTRIC HOT WATER TANKS (NOTE: if gas water tank,see mechanical) x $6 = $
B12 FLOOR DRAINS AREA CASE,COIL,TRENCH,CONDENSATE X $6 = $
B.13 ROOF DRAINS/OVERFLOW DRAINS(ea.) - x $6 = $
B14 FOUNTAINS,DRINKING — x $6 = $
B::15 WATER PIPING/DRAIN-WASTE-VENT/ INSTALLATION,ALTERATION,REPAIR, X $6 = $
PLUMBING REVERSALS REVERSALS ,
1316 SEWAGE EJECTORS GRINDER,SUMP PUMP X $6 = $
B17 WATER USING DEVICES ICE AND/OR COFFEE MAKER, X $6 = $ "
HOSE BIB,STEAMER,PROOFER,
CARBONATOR,SWAMP COOLERS
B1$CROSS—CONNECTION DEVICES VACUUM BREAKER CHECK VALVE, x $6 = $
AND R.P.B.P.D.FOR:VATS,SUMPS
TANKS,BOILERS,&SPRINKLER SYSTEMS
B.191NTERCEPTORS GREASE TRAP,SAND TRAP, x $6 = $
? CHEMICAL HOLDING TANK
520 MEDICAL GAS(per outlet/bottle station) NrrROUS,OXYGEN x $6 = $
B2I MISCELLANEOUS FIXTURES x $6 = $
NOTE: MINIM LTMPERMIT FEE IS$35.00 Subtotal 42 4 _
PLUS: PROCESSING FEE $25.00
SIGNATURE: TOTAL PERMIT FEE DUE $ 9. r-
PLEAsE MAKE CHECKS PAXAP. m
;pokane County Division of Buildings SPOKANE COUNTY PERMIT CENTER;:
026 W.Broadway Avenue • Spokane.WA 99260
'el.No.(509)456-3675 • Fax No.(509)456-4703 •TDD No.(509)324-3166
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