HomeMy WebLinkAbout1994, 10-28 Permit App: 94011038 Sewer S12-
SEWER
12SEWER CONNECTION PERMIT
APPLICATION FORM Cj /j 1 (03?
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:
/No? /-s - 2&1 ,a,/ 1,A
City: . i�+,y� City/State44 i Ai?
Zip: 09,21,/, Zip: 99,746
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:
4-4 S Cons S an'`1 4E- 11;3 F
Business address: Utilities installers permit number:
I I . V ci,l IF/f v�IC0 y
City/State: S o AX't' II
Zip: q q 2,o Phone: c 2 - S G c,L1-
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) _ $
TOTAL FEE
(One permit required for each separate building, shop,garage, etc., that will be connected to the sewer)
APPLICANT SIGNATURE: 4,0/-0_. ,/ Date:
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675
I
•
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 PLIRDBY /UNIT RQUAL$ AMOUNT
B02 TOILETS WATER CLOSETS,BIDETS x $6 = $
B03 URINALS - x $6 = $
B04 TUBS BATH,JACUZZI,SPA.GARDEN x $6 = $
505 SHOWERS(per trap) BASE,STALL,ON-SITE BUID X $6 = $
B06 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN, x $6 = $
LAUNDRY,UTILITY,JANITOR,PHOTO,
X-RAY,FOOD(PREP/CULINARY/MEAT)
.
B7
DISHWASHER - x $6 = $
B08 CLOTHES WASHER - x $6 = $
BOO GARBAGE DISPOSAL/GRINDER - x $6 = $
B10 WATER SOFTENER - x $6 = $
B11 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 = $
BI4 FOUNTAINS,DRINKING - x $6 = $
B15 WATER PIPING/DRAIN—WASTE—VENT/ INSTALLATION,ALTERATION,REPAIR, X $6 = $ Up
PLUMBING 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,
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
B19 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6 = $
CHEMICAL HOLDING TANK
1320 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 $ 5----1-
PLEASE MAKE CHECKS PA,`YABIE TO;.
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County Division vtsio
n of Buildings
P
ySPOKANE COUNTY PERMIT CENTER
026 W. Broadway Avenue * Spokane,WA 99260
rd. No.(509)456-3675 * Fax No. (509)456-4703 *TDD No.(509)324-3166
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