2000, 03-13 Permit App: 00001538 SewerSpokane'Couniy Division of Utilities
J
3._SV 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.
Also note that sewer permits are valid for 12 months from the date of issuance. No extensions will be granted.
PROJECT INFORMATION
Job address:
757'' 6./2
City:
Zip:
Dry Line
Sewer? (
Parcel number (if known
Owner's name:
City/State:
Zip:
Phone:
-x1451
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 Division person contacted:
CONTRACTOR INFORMATION
Contractor (company name):
(LC , L T, ` I u Cil 0 t\
State contractor license number:
1 Ecce -Z.(:) UH (2
Business address:
C,c �� �. K is y �c ►� 12�-�
City/State: O.t—kC_ IVsc`� IA) A
Zip: CA9 LC L Phone:
Contact Name:
Phone: q 3 -1 - (C% C�
INTERIOR PLUMBING ALTERATIONS? (yes
1 out the in ormation in the table below i a. ,licable**
Phone: q )� 15
Contractor (if different fiom above):
Business Address:
City/State/Zip:
le one
•
For: pluriibirig reversal; fee tnf irmr ha
ovome:strle: of this form
FEE INFORMATION
Sewer Connection: Number of Buildings / X (times) $100 (per bldg) = $ j (j 0,00
TOTAL FEE
• For a single-family residential unit, one permit is required;
• For a condominium, townhouse, duplex, triplex or fourplex with separate ownership (as determined by lot lines) separate
address and separate stub, one permit is required per address per stub;
• For a single building duplex, triplex or fourplex with single ownership, one permit is required
• Multiple buildings (apartments, industrial complexes) with single ownership, one permit required per building connecting to
the sewer.
(For situations not covered here, call the County Division of Utilities ® 456-3604)
APPLICANT SIGNATURE: Date:
Spokane County does not dtsmaa.ate c:. = e as o: c-er.- ::. _.< a4._sto n to, or nest -nem or emp
Return to:
Spokane County Division of Building & Planning
Fest 1026 Broadway Avenue * Spokane, Washington 99260
PI -ZONE: (509) 456-3675 ' FAX: (509) 324-3198 * TDD: (509) 324-3166
rta progtamc 01 acbvtnes 0111194
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER:
PHONE: DAYTIME CONTACT
MAILING ADDRESS:
CONTRACTOR:
(street)
t,k:,t \ l'LLA►) l h J I\.; (,
(city/state)
(zip)
MAILING ADDRESS: 1 €-•)_)( t L% Y L1 1
(street)
LICENSE: f _,;TLS! 1)* 08 E-1/1/1 T
PHONE:
(city/state) (zip)
TOILETS
URINALS
TUBS
PLUMBING FIXTURES
DESCRIPTION DETAIL
SHOWERS (per trap)
SINKS
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL/GRINDER
WATER SOFTENER
ELECTRIC HOT WATER TANKS
FLOOR DRAINS
ROOF DRAINS/OVERFLOW DRAINS
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-WASTE-VEN
PLUMBING REVERSALS
SEWAGE EJECTORS
WATER USING DEVICES
CROSS -CONNECTION DEVICES
INTERCEPTORS
WATER CLOSETS, BIDETS
BATH, JACUZZI, SPA, GARDEN
BASE, STALL, ON-SITE BUILD
MEDICAL GAS (per outlet/bottle station)
MISCELLANEOUS FIXTURES
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD (PREP/CULINARY/MEAT)
(NOTE: if gas water tank, see mechanical)
AREA, CASE, COIL, TRENCH, CONDENSATE
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
GRINDER, SUMP PUMP
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMI' COOLERS
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P_D. FOR: VATS, SUMPS,
TANKS, BOILERS, & SPRINKLER SYSTEMS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
NITROUS, OXYGEN
NOTE: MINIMUM PERMIT FEE IS $35.00
❑ RESIDENTIAL ❑ COMMERCIAL
SIGNATURE:
# OF
UNITS
MULTI-
PLIED BY
X
x
x
x
x
X
x
x
X
x
x
X
x
x
x
x
x
X
x
x
COST
/UNIT
$6
$6
$6
$6
$6
$6
$6
$6
$6
$6
$6
$6
$6
$6
$6
$6
$6
$6
$6
$6
Subtotal
EQUALS
AMOUNT
$
$
$
$
$
$
$
$
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
$
Spokane CountyDivision of Building & Planning YISXJ*tI{>lt7:t3i<7L:k7kC111;c 7+x`i:;:s
1026W.
Broadway Avenue *
Spokane,
WA 99260
...
Tel. No. (509) 456-3675 * Fax No. (509) 324-3198 * TDD No. (509) 324-3166
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities.
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