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
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