1995, 03-16 Permit App 95001453 Plumbing Fixtures9,5 l(-I-,5
PROJECT ADDRESS:
PLUMBING PERMIT _R..PPLICATION
OWNER:
PHONE:
MAILING ADDRESS:
(street)
CONTRACTOR: /\die
MAILING ADDRESS: /72,c7% afjje'27 �`
(street)
(city/state)
(zip)
LICENSE:
PHONE: 9�,---908-'
(city/state)
(zip)
B02
TOILETS
PLUMBING FIXTURES
DESCRIPTION
DETAIL
WATER CLOSETS. BIDETS
# OF
UNITS
MULTI -
PIXED BY
x
COST
/UNIT
$6
RQUALS
AMOUNT
$ 4�
B03
URINALS
x
$6
$
1304
TUBS
BATR JACUZZI. SPA. GARDEN
x
$6
)306
B07
SHOWERS (per trap)
SINKS
DISHWASHER
BASE, STALL, ON —SITE BUILD
IAVSBASINS, BAR. FLOOR, KITCHEN.
LAUNDRY, ITDLITY, IANITOR, PHOTO,
X—RAY, FOOD (PREP/CULINARY/MEAT)
x
x
x
$6
$6
$6
B08
B09
B10
CLOTHES WASHER
GARBAGE DISPOSAIJGRINDER
WATER SOFTENER
x
x
x
$6
$6
$6
$
$
$
B11
B12
B13
B14
B15
B16
B17
BI8
B19
ELECTRIC HOT WATER TANKS
FLOOR DRAINS
ROOF DRAINS/OVERFLOW DRAINS (ea.)
FOUNTAINS, DRINKING
WATER PIPING/DRAIN—WASTE—VENT/
PLUMBING REVERSALS
SEWAGE EJECTORS
WATER USING DEVICES
CROSS —CONNECTION DEVICES
INTERCEPTORS
(NOTE: if ltas water tank, ace mechanical)
AREA, CASE. COIL. TRENCH, CONDENSATE
INSTALLATION, ALTERATION, REPAIR.
REVERSALS
GRINDER SUMP PUMP
ICE AND/OR COFFEE MAKER
HOSE BIB, STEAMER, PROOFER,
CARBONATOR. SWAMP COOLERS
VACUUM BREAKER CHECK VALVE,
AND R.P.B.PD. FOR: VATS SUMPS,
TANKS. BOILERS. & SPRINKLER SYSTEMS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
x
x
x
x
x
x
x
x
x
$6
$6
$6
$6
$6
$6
$6
$6
$6
$
$
$
$
$
$
$
B20
B21
MEDICAL GAS (per outletibottle station)
MISCELLANEOUS FIXTURES
NITROUS OXYGEN
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE:
Spokane County Division of Buildings
1026 W. Broadway Avenue • Spokane, WA 99260
Tel. No. (509) 456-3675 • Fax No. (509) 456-4703 • TDD No. (509) 324-3166
YNfT[RTLU PERKHND
x
x
$6
56
Subtotal
$
$
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
$ v0
.PLEASE MAKE CHECKS PAYABLE TO
SPOKANE COUNTY:PERMIT CENTER:
`j5<5
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.
PROJECT INFORMATION
Job address:
/s/,S�a
Parcel number (if known):
Owner's name:
Phone:
g'9/-/949
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):
14 -5 Cons 4-,(-- A c.+; o n
Business address:
I18tVa.\U'\(vo
City/State: ,4 p14rtf e ff WA
Zip: g q 2,0 tc Phone: G - S q (0r-I-
State contractor license number.
I-15 Cr aE 12.77 atP
Utilities installers permit number:
INTERIOR PLUMBING ALTERATIONS (if applicable)"
Contractor (if different from above): Phone:
City/State/Zip:
Business Address:
** For plumbing reversal fee information, see reverse side of this form.
FEE INFORMATION
Sewer Connection: Number of Buildings X (times) $50 (perbldg) _ $
TOTAL FEE
(One permit required for each separate building, shop, garage, etc., that will be connected to the sewer)
APPLICANT SIGNATURE: (X4Date: 2 r"—
nexisainaa
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675