1994, 10-19 Permit App: 94010481 Sewer q14-,S . 11r71
SEWER CONNECTION PERMIT
APPLICATION FORM (14- 101V1
PLEASE NOTE: This application form must be filled out accurately and in its entirety, and signed,
or a permit will not be issued.
PROJECT INFORMATION
Job address: Owner's name:
3fo -S. � , G ." 2/ a-
City' City/State:
2�',�
Zip: 9. ' 26 Zip:
Parcel number (if known): Phone:
WILL THE PROPERTY OWNER BE PERFORMING THE SEWER CONNECTION
INSTALLATION?* Yes No
*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:
firms-1 gyp n 3 cons-I'r u c--1--i on ,A.Q.M.s-t'C, - 1..G 2 tJ 1
Business address: Utilities installers permit number:
Po 6a ILI-2 tE 2
City/State: ,5 p 2.‘C�r, V/A
Zip: q ci 21 Li- Phone: q 2 S - 0 5 5 q
INTERIOR PLUMBING ALTERATIONS (if 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) _ $ L
TOTAL FEE
(One permit required for each separate buildin , shop,garagtc., that will be connected to the sewer)
0
APPLICANT SIGNATURE: 7) /-L Z Date: D /<
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: An b _\_ `�c:)v-I n O(I LICENSE:4D A j P S 81
PHONE: 0
MAILING ADDRESS: 1 r1 S�Q E /_,�,{r `�(tee Pte,�re,c WA q R o 1(n
Y� (street) (city/state) (zip)
PLUMBING FIXTURES #OF MULTI- COST
DESCRIPTION I DETAIL UNITS PUBES BY_ /UNIT EQUALS AMOUNT
B.02 TOILETS WATER CLOSETS,BIDETS x $6 = $
B03 URINALS - x $6 = $
B04 TUBS BATH,JACUZZI,SPA,GARDEN x $6 = $
13.0.5 SHOWERS(per trap) BASE,STALL,ON-SITE BUILD X $6 = $
B06 SINKS IAVSBASINS BAR,FLOOR,KITCHEN, z $6 =
LAUNDRY,UTILITY,JANITOR,PHOTO,
X-RAY,FOOD(PREP/CULINARY/MEAT)
B07 DISHWASHER - x $6 = $
B08 CLOTHES WASHER - x $6 = $
1309 GARBAGE DISPOSAUGRINDER - x $6 = $
:BIO WATER SOFTENER - x $6 = $
1311 ELECTRIC HOT WATER TANKS (NOTE: if ps water tank,see mechanical) X $6 = $
1312 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE x $6 = $
13 ROOF DRAINS/OVERFLOW DRAINS(ea.) - x $6 = $
B14 FOUNTAINS,DRINKING • - x $6 = $
;Bi$WATER PIPING/DRAIN-WASTE-VENT/ INSTALLATION,ALTERATION,REPAIR x $6 = $
PLUMBING REVERSALS REVERSALS
$16 SEWAGE EJECTORS GRINDER,SUMP PUMP x $6 = $
B:17 WATER USING DEVICES ICE AND/OR COFFEE MAKER, x $6 = $
HOSE BIB,STEAMER,PROOFER,
CARBONA1DR,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
B19INTERCEPTORS GREASE TRAP,SAND TRAP, X $6 = $
CHEMICAL HOLDING TANK
`$20 MEDICAL GAS(per outlet/bottle station) NITROUS,OXYGEN x $6 = $
B21 MISCELLANEOUS FIXTURES x $6 = $
NOTE: MINIMUM PERMIT FEE IS$35.00 Subtotal
`
PLUS: PROCESSING FEE $25.00
SIGNATURE: TOTAL PERMIT FEE DUE $
PLEASE 4404EGKS TAXABLE TQ;
Spokane kane
County DivisionBuildings SPOKANE COUNTY?414fIT CENTER
1026 W. Broadway Avenue • Spokane,WA 99260 <:
Tel.No.(509)456-3675' Fax No.(509)456-4703*TDD No.(509)324-3166
WAFTER PWMP* KHND