1996, 04-08 Permit App: 96002175 Plumbing Fixtures 1 - - i `76 PLUMBING PERMIT APPLICATION
PROJECT ADDRESS: •l// 91/ e" 9 54-/---
OWNER: A 4,4_yy a A I • PHONE:DAYTIME CONTACT ` d - /
MAILING ADDRESS: j ✓II A/_i� ! i — A
(street) (city/.tate) (zip)
CONTRACTOR: �n‘,j,er ,)nhn, LICENSE: A e b A J Q ( c I
• PHONE: 911 • g O g tA
MAILING ADDRESS: J q 5 2r) e" (,;4-te, qr,r,C./\Glrre_S v/A c'l (3(1i-,
(street) (city/state) (zip)
PLUMBING FIXTURES #OF aann- COST
DESCRIPTION I DETAIL UNITS rsunar /UNIT .Daus AMOUNT
B.:2 TOILETS WATER CLOSETS BIDETS / x $6 = $(..On
:BO3 URINALS - x $6 = S
m TUBS BATH,JACUZZI,SPA,GARDEN x $6 = S,
. 5 SHOWERS(per trap) BASE,STAB,ON—SITE BUILD / x $6 = Si
ao
:1306 SINKS IAvsIBASINs,MR,FLOOR,KITCHEN, x $6 = $
•
IiiiIiiiiii LAUNDRY,UTILITY,JANITOR PHOTO, /
X—RAY,FOOD(PREP/CULINARY/MEAT)
Bbl DISHWASHER ' • • - x• $6 = $
:B08 CLOTHES WASHER - x $6 = $
B.O9 GARBAGE DISPOSAL/GRINDER - x $6 =. S
.I0 WATER SOFTENER - . , x $6 = $
1111 ELECTRIC HOT WATER TANKS (NOTE:if gas water tank.sce•mechauical) x $6 $
B. FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE x $6 = $
i.B13 ROOF DRAINS/OVERFLOW DRAINS(ea) - x $6 = $
3314 FOUNTAINS,DRINKING - x $6 = $
BO WATER PIPING/DRAIN-WASTE-VENT/ INSTAL ATIoN,ALTERATION,REPAIR, 4.. x $6 = S
'<.> PLUMBING REVERSALS REVERSALS
'1 t6 SEWAGE EJECTORS GRINDER,SUMP PUMP / x $6 = $ 6
B17 WATER USING DEVICES • ICE AND/OR COFFEE MAKER, x $6 = $
HOSE BIB,STEAMER PROOFER, •
CARBONATOR,SWAMP COOLERS
B18 CROSS-CONNECTION DEVICES VACUUM BREAKER,CHECK VALVE. x $6 = ,$
AND R.P.B.PD.FOR:VATS,SUMPS,
TANKS,BOILERS,&SPRINKLER SYSTEMS
$19 INTERCEPTORS • GREASE TRAP,SAND TRAP, x $6 = $
CHEMICAL HOLDING TANK
B.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 $25.00
SIGNATURE: ii/fiZill/Z46.-4C1974-4)1TOTAL PERMIT FEE DUE S
Pt-PASE;MAS:CCK$PAYABLE Ta
Spokane County Division of BuildingsSPOKANE COUNTY PERMIT'CENTER
1026 W.Broadway Avenue•Spokane,WA 99260 ,,,,,,,,,,,..,:,:::::::,::::::,::.:•:.:::.::.::..:::::.:::.
'
Tel.No.(509)456-3675•Fax No.(509)324-3198•TDD No.(509)324-3166
Spokane County does not discriminate on the basis of disability in the admission to,or treatment or employment in.its programs or activities.
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SEWER CONNECTION PERMIT
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 note that sewer permits are valid for 12 months from the date of issuance. No
extensions will be granted.
PROJECT INFORMATION
Job address: Dry Line Owner's name:
Sewer? (Y/N)
City: City/State:
Zip: Zip:
•
Parcel number(ifknown): Phone:
First-time contractors or home-owners performing the installation must first contact the utilities department(in person
or via phone[456-3604]) before a permit can be issued.
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Contractor(company name): State contractor license number:
Z - 8.es-i- Cone-Frucion Z c.* 9)-71124
Business address: Utilities installers permit number:
to el, o a ct kda.i
City/State: 5 py�cE Re.- WA
9 c12.12. I' Phone: B41 - q 9 L-I-G
INTERIOR PLUMBING ALTERATIONS9no) circle one
Fill out the information in the table below if applica e *
Contractor(if different from above): Phone: CJ 2.i • G O 815
Ac C-l- J kohn5e7n
Business Address: City/State/Zip:
2.0 e . r'ccna cr4 c WA Ci to/4
^r!!!k!F
c::.: +:x:�:;::;:k�"!:I Nri� .�:i; :!::�x. ';hL:'7.:��If ni:ji.�. .::�ilzi�:�•'• xx::::::.. x:::!��':[::�e:'I!;.:,�Ii hi!:,:x
GM1 00 nr!tr�4 kiU:�.. p. plr umblrg ry ei vem.:;t"F'. ... y..:u' prlQ::xe D� gg.t ai g!I v:. . ...:n o�r,:,.in r.Sy�i!aV,fAI �.. !,"41I,1� p+01
FEE INFORMATION
Sewer Connection: Number of Buildings X(times) $50(per bldg) _ $
TOTAL FEE
*One permit required for each separate building, shop,garage, etc.,that will be connected to the sewer.
*Condos,townhouses, &2-3-and 4-plexes require I 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: Date:
onoaincis
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260
PHONE: (509) 456-3675 * FAX: (509) 324-3198 * TDD: (509) 324-3166
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in,its programs or activities.