1994, 11-16 Permit App: 94011476 Piping 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 /UNIT EQUALS AMOUNT
B02 TOILETS WATER CLOSETS,BIDETS X $6 = $
B03 URINALS - x $6 = $
1304 TUBS BATH,JACUZZI,SPA.GARDEN X $6 = $
B05 SHOWERS(per trap) BASE,STALL,ON—SITE BUILD X $6 = $
1306 SINKS IAVS/BASINS,BAR,FLOOR,KITCHEN, X $6 = S
LAUNDRY,UTILITY,JANITOR,PHOTO,
X—RAY,FOOD(PREP/CULINARY/MEAT)
B07 DISHWASHER - x $6 = $
B08 CLOTHES WASHER - x $6 = $
1309 GARBAGE DISPOSAL/GRINDER - x $6 = $
1310 WATER SOFTENER - x $6 = $
1311 ELECTRIC HOT WATER TANKS (NOTE: if gas water tank,see mechanical) X $6 = $
B12 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6 = $
B13 ROOF DRAINS/OVERFLOW DRAINS(ea.) - x $6 = $
1314 Fes_DRINKING - x $6 = $
5 WATER PIPI is RAIN-WASTE-VENT/ INSTAILATION,ALTERATI REPAIR X $6 = $
t G REVERSALS REVERSALS
B16 SEWAGE EJECTORS GRINDER,SUMP PUMP X $6 = $
B17 WATER USING DEVICES ICE AND/OR COFFEE MAKER, X $6 = $
HOSE BIB,STEAMER,PROOFER,
...f,
CARBONATOR,SWAMI'COOLERS
B18 CROSS-CONNECTION DEVICES VACUUM BREAKER,CHECK VALVE, X $6 = $
AND R.P.B.P.D.FOR:VATS SUMPS,
TANKS,BOILERS,&SPRINKLER SYSTEMS
E19 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 $ 36, ad
PLEASE MAKE CHECKS PAYABLE TO:
Spokane County Division of Buildings SPOKANE COUNTY PERMITCENTER
1026 W. Broadway Avenue $ Spokane,WA 99260
Tel.No.(509)456-3675 $ Fax No. (509)456-4703*TDD No. (509) 324-3166
MASTERWLUMPERM.IIND
3
SEWER CONNECTION PERMIT c l L l 4-k.
APPLICATION FORM 1
PLEASE NOTE: This application form must be filled out accurately and in its entirety, and signed,
or a permit will not be issued. Also mote that sewer permits are valid for 12 months from the date
of issuance. No extensions will be granted.
PROJECT INFORMATION
Job address: Dry Line O 's n7:z.z.
C c' Z �� / -� Sewer? (Y/N)
City: . -7z}--- City/State:
Zip: Zip:
Parcel number (if known): 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 Department person contacted:
CONTRACTOR INFORMATION
Contra tor company name): State contractor license number:
"rj-
Business address: Utilities installers permit number:
/?e/
City/State:
Zip:99- / '/ Phone: 2 d J-- -7
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) = S
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-pier require I permit per address/stub.
* Multiple buildings (apartments, industrial completes) require I permit per building.
(For situations not covered here, call the County Utilities Division n) 456-3604)
APPLICANT SIGNATURE: Date:
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675