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1999, 09-17 Permit App: 99008726 Sewer/roNpE296li r1o16-cD Spokane County Division of Utilities SEWER CONNECTION PERMIT • APPLICATION FORM - Q9_ 577� PLEASE NOTE: This application form must be filled out accurately and in its entirety, and signed, or a permit will not be issued. Also note that sewer permits are valid for 12 months from the date of issuance. No extensions will be granted. PROJECT INFORMATION Job address: n/)�� / g,.ti G G. o+es AQd City - Zip: ity- Ztp: Sp©rilate 99,10(0 Parcel number (ii:aawn). 9917/ DLDa Owner's name: T n 01. Cenpar City/State: Zip: 99a (c Phone: (61E) Rg.a-y 90 . st-time contractors cr home -owners pe.-tbrmmg the iris -Equation nus: first contact the utilities department (!n: erten cr vie: hone -':6-36041) bel -ore a permit can be issued _ Name of Utilities Division person contacted:O j p 15SUES%Ve'LJNE T t t CONTRACTOR INFORM ATIO t -q Contractor (company name): /.)trm IS FXCavaIiiiq mousiness address: J State contractor license numcer: Cirr'State. Zip: Phone: Contact Name: Phone: INTERIOR PLUMBING ALTERATIONS? (yes/no) ClT:aono Fill out the infarmatan in the table below if applicable'* Cont:ac:or (if different from above): Phone: Business Address: City/Stat etZip: ' `'Far plumbing reversal fee infarmntsan,.see reverst side. nf this jorm. . FEE INFORMATION to 3 ter Connection: Number of Buiidinss 1 X(tiac) 3100 (perbldg = S l0 0" TOTAL FEE • For a single-fami!,' residential unit, one perm is required; • For a eandoneinium, townhouse, dupla, triplex or fourplc with separate ownership (as determined by lot lines) sepcade address and separ=e stub, one permit is required per address per stub; • For a single building dupla, triple or fourpla with single ownership, one permit is required • .Nuf^ple buildings (apartrtens, industrial comp/res) with single ownership, one permit required per building conneeing to the sewer. (For situations not covered here, call the County Division of Utilities r 456-3604) APPLICANT SIGNATURE: Date: 9// RCUM ta: • J.ieiae Gun). Didion of? s L ?tannins rat 1026 Bnatici Ateerue ' StnSpoi-zne, Warhwswn 99260 PHONE (509) 456.3675 • FAX (509) 324,-3193 • TDD. (509) 324-3166 *or .n.:.awn Ion nal 4Y.w,wu,n2.).a. at Iw.un a -.a. .anon,.. a,Ssi 74 .t Sy...na Rs lope^• u ca+.w PLUMBING PERMIT APPLICATION •., PROJECT ADDRESS: OWNER: PHONE: DAYTIME CONTACT MAILING ADDRESS: CON."TR_ACTOR: (street) (city/state) (zip) ---- • LICENSE: PHONE: MAILING ADDRESS: (city/state) (zip) i 1 FLUNIT'aING FIXTURES 1 DESC_RIPTION DETAIL 4 OF I MUL73. I COST 1 UNIT51 Pr ...:,ED 3Y /UNIT I EQUAL AMOUNT 12.01170[LETS I w \ C." -CSE -73. n:ZE 1 1 x 1 56 1 = 15 iS.03i i URIN.A LS• • x S6 I = IS Ii2C4 7.-_S 3A, :A C:. SPA_ GARCEN •X s6 ! = Is Sas ,SHOW:_: -.7._; 1 per 77.,e). ' BASE. STAL... CS-Sti-E BUILD X Sc5 1 = IS 111,-,06 ... ST: i : 7 ( . . .5 L.VIST/ASMS. 8A2.. FI.CCR. KI7CHE`i.' L.ALNT2 AY, LIT...: -71. 1.4.`-rriCR, ?!-EC-rC, . 36 =. 5 i SOT DISHWASHER. • x 36 I = 5 fe.03 CLOT -ES W3,5 -ER . x 55 I = 5 1E09 GA?ACE DISFOSALJGR.INDE.P. - x 55 = 5 IISIO WATER SOFTENER - x S6 = S 13 IT, ..-:LIECTRIC HOT WATER TANKS - NOTE.: if ps ..as.cr tank. see .7=c...um:zit) . x . 56 = 3 1a12 FLOOR DRAINS A.I.F...•1/4. C.ASE, CCIL. TRENCH. CCNCENSATE x 36 = 5 1313: : R.COF IDR.-kiNSiOVERFLOW DRAINS ..•x 56 = 5 .. 11:4-. FOUNTAINS. DRINKING • x 56 = 5 IBI.5... i ..i........•.::: •,:./.-k7:-2, P1?1NCIDR.AIN-W.A.S71....-VEN INS7.-U_LA7CN..A.L.--21...kr:CN. az-2Aa. x Pr tiNf":2 NG REV=7.SALS RE: r.i.74S Al- S So- = 5 .15 "'",vAC:::: ."--.7- C7r)RS— • , c .....s. -k. SCP ? r..".k.f.? 1 1 X 56 = S 131.7. W.A.-7F. USi-NC 1-L'E.VICEStc:.-: ANT.',C R CC FFEE MAKZR. i-:CS.7. 3M. SE -A.%. MCCFE74.... CA.22,CNATCP.. SwAMP cr-cLiRs x 1 36 = .13 IBIS: CROSS-COWi(.77.10N CEVIGE.S VAC...1.7.4 3ri.A.KER. CriECC VALVE. AND R.? 32 O. FCR: VAr.:, st.NPS. TAN -K2,. 3ca.zas. A sPRINKL22 SY..=.4._ S x 56 = 5 13191.7\--ERCE?TOSS IcazkzETRA2. SAND 7:4_,{2, C:-.7.-2,CCAL HCLDING TANK :( 36' = 5 13C; IM7_,IC..l.. C. S f :: V' 3utfe...1-...cr.`.e staticrtilsr7ces. C:CfCEN. ,.. X 56 = 5 r--:..'-';..1:\,EISCILL.A.NECTjS FiXTJ? 1 x 55 = 13 ,y07,_7.- 11,(T\i-fti,_rr ,r,i,y- p ;7? /fT 2- F t-7,-17 15 s35.00 Subtotal PLUS: PROCESSMIG FEE. I S25.00 71 RL-TSTD7NTIAT 0 CONS\ifERCLA_L TOTAL PERINI1T FEE D LrE 5 PtEASE:INI.AKE:CHECI.a. PA Ir-3:LE:.:TO Spokane Caunry Division or Building & Planning r."S?01.1.-E:.COUNTY' ' CENTER .. 10:6 vv. Broadway Avenue ' Spokane. NVA, 99260 f:-:':::::":':•Y3''''':•:'.i':-..• TL No. (509) 45O-3075 • Fax No. (509) 324-3193 • TDD No. (509).37.4-3166- Scokane Catudy dots not discriminate on Lc oasis of disabiliry in die admission o. or treatment or :imp Ioyment in, it:: ;rograms or activities. I 4..V.•••asevmo Nal