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1994, 10-11 Permit App: 94010075 Sewer . SEWER CONNECTION PERMIT ETA a l I 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. PROJECT INFORMATION Job address: Owner's name: C Cit State: ....5e,/9 /C/9-/►/ Ey/ /4A- Zip: Zip: Parcel number(ikno1n)4? A aL. Co 6 I Phone: y5;2r . 9(7?c173 (24--/ WILL THE PROPERTY OWNER BE PERFORMING THE SEWER CONNECTION INSTALLATION?* Yes V No *If property owner is installing the sewer connection, they must firs contact the UTILITIES DEPARTMENT for construction requirements before the permit is issued. CONTRACTOR INFORMATION Contractor (company name): State contractor license number: Le_ Cons-1-rLc-4- oun 1"L.CcO ±o"1 MCy Business address: Utilities installers permit number: (39, 1 (0 E , I2-' Ave. City/State: \5p0.11,can vJA G12_,(Zip: cl � Phone: cf 2,1 - INTERIOR PLUMBING ALTERATIONS (if applicable)** Contractor (if different from above): Phone: 47. 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) _ $S-6, 0 0 TOTAL FEE (One permit required for each separate building, shop,garage, etc., that will be connected to the sewer) APPLICANT SIGNATURE: _ `_ ,; ; Date: /0 9e4 *wow.* Spokane County Division of Buildings West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675 • PLUMBING PERMIT APPLICATION 0 OC' T9 PROJECT ADDRESS: /// ?/ , /t_ � OWNER: /1 ) ,p SI/ fV 201 /1 /9A- PHONE: 94aa 7 30; MAILING ADDRESS: / //a ( fT /( /< _ /A. / , /n (street) ( y/state( /Y ✓(//7 62e9 / ) (zip) CONTRACTOR: /_, , �. , AY�T1 LICENSE: ((( ( PHONE: ?.a 2--6 76 0 MAILING ADDRESS: / 3 (/' /, ( 02 f/ ( (street) (city/state) (zip) PLUMBING FIXTURES # OF bruin- COST DESCRIPTION I DETAIL UNITS PLIED BY /UNIT EQUALS AMOUNT B02 TOILETS WATER CLOSETS,BIDETS x $6 = $ B03 URINALS - x $6 = $ 1104 TUBS BATH,JACUZZI,SPA,GARDEN X $6 = $ 1305 SHOWERS(per trap) BASE,STALL,ON-SITE BUILD x $6 = $ B06 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN, x $6 = $ LAUNDRY,UTILITY,JANITOR,PHOTO, X-RAY,FOOD(PREP/CULINARY/MEAT) 1107 DISHWASHER - x $6 = $ B08 CLOTHES WASHER - x $6 = $ IB09 GARBAGE DISPOSAL/GRINDER - x $6 = $ 1110 WATER SOFTENER - x $6 = $ B1'1 ELECTRIC HOT WATER TANKS (NOTE: if gas water tank,see mechanical) x $6 = $ B12 FLOOR DRAINS AREA,CASE,COB,TRENCH,CONDENSATE x $6 = $ B13 ROOF DRAINS/OVERFLOW DRAINS(ea.) - x $6 = $ B14 FOUNTAINS,DRINKING - x $6 = $ B15 WATER PIPING/DRAIN-WASTE-VENT/ INSTALLATION,ALTERATION,REPAIR, x $6 = $ PLUMBING REVERSALS REVERSALS CD B16 SEWAGE EJECTORS GRINDER,SUMP PUMP x $6 = $ B11 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.P.D.FOR:VATS,SUMPS, TANKS,BOILERS,&SPRINKLER SYSTEMS 1319 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6 = $ CHEMICAL HOLDING TANK B20 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 MAKE CHECKS PAYABLE TO ;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 IAJTBRVLUMp&RJAHND