1999, 10-05 Permit App: 99009376 Sewer, Plumbing FixturesSpokane County Division of Utilities
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 X12 months form the date of issuance. No extensions will be granted.
PROJECT INFORMATION
Job eGG g (c y Dry Line Sewn? Owner's snare: yrX
99 -9
Zip:
Peal Number (if known):
City/Stats
Zip:
Phone:
First-time contractors or home -owners performing ibe installation must first contact £he Utilities Division in person or via phone f436•J60I1) before a
permit can be lamed.
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Contractor (company name) CCI
.CENTERLINE CONSTRUCTION INC.
swims. sums, P . O . BOX 1 138 •
aty/statc.. RATHDRUM ID. 83858
Sate contractor license number.
CENTECI123NE
Conus Name:
Phone Number..
•
INTERIOR PLUMBING ALTERATIO
o) circle one
Fill ora the infonnaaon in the table below bk• •
Contraaor (if different from abort):
B•utir ; Address:
Phone:
Ci:,/rt:te/Zip
**For plumbing reversal fee information, sit reverse side p%tbirform.
FEE INFORMATION
t/ X (times) $100 (per bldg) — S
Sewer Connection: Number of Buildings
• For a tinglahmily residential unit, one permit is required;
• Por • 000dominium, townhouse, duplex, triplex or fourpkz with separate ownership (u dccermined by lot lines) separate address and separate stub, one
permit is required per address per nub;
• For a dn& building duplex, triplex or fourp ex wish single owns; -.hip. am purest is regain:d
• Multiple buildinsa (apartments, industrial completes) with single ownership, one permit required per building conneaing to the sewer.
(Por situations not covered here, call the County Division of Militia 0456360i)
TOTAL FEE
APPLICANT SIGNATUI r
m4ye,
DATE:
Method of Payment:
• Q Cash ❑ Check D Visa D MasterCard 0 Discover Card
Date: Expires.
Bankcard Number:
Authorized Signature•. .
Spokane County Division of Building & Planning
1026 \Vest Broadway Avenue * Spokane WA 99260
Tel. No. (509) 456.3675 * Fax No. (509) 456.4703 * TDD No. (509) 324.3166
PLUMBING PERMIT APPLICATION
Spokane County Division of Building Planning
1026 Wert Broadway Avenue * Spok.iw WA 99260
Tcl. No. (509) 456-3675 *Fax No. (509) 3243198 * TDD No. (509) 324.3166
1211 f/I) a we.VlNobpuwb
ROJECT
•Ift3RESS:
PERMIT
USE:
.... . ..._._........ ---.--------------------.... -••-
TWNER _ -
PHONE: DAYTIME CONTACT
_A; JUNG ADDRESS:
street
c ty state zsp
:ONTRACTOR:
LICENSE:
•
PHONE:
_AILING ADDRESS:
Strut
(city/State) {z3
PLUMBING FIXTURE'S
DESCRIPTION •
DETAIL �rUNITS
1 OF �wucTV
tnim.Y
COST
/UNIT
reuus
AMOUNT
Oft
OILE'TS
WATER CLOSETS, BIDETS
x
$6
-
S
3d• 3:
URINALS$6
x
S6
-
S
INA:
TUBS
aATH.1ACUZ7.I. SPA. GARDEN
x
$ 6
—
5
ice:
SHOWERS (par trap)
aASE, STALL, ON-SITE BUILD
x
$6
—
S
( 1
:.:.•:
smcs
LSVe..J'VM6,1AR. FLOOR, xrrcHEN.
LAUNDRY, UTILITY, JANITOR. PHOTO.
XRAY, FOOD (PREP/CULINARY/MEAT)
x
$6
-
St ,
X:
DISHWASHER
x
56
•
CLOTHES WASHER
•
x
S6
—
$ --.
c'
GARBAGE DISPOSAL/GRINDER
x
_ S6
—
S
:
0:
WATER SOFTENER
•
x
56
—
S
.I
-i'M:
ELECTRIC HOTWATER TANKS
NO TFs fps wtet uah, > e m.ch&s cs1)
S
ul.i
FLOOR DRAINS
A1tFA CASE.con, 'RiENCtt CONDEIISATE (
S X
14:
FOUNTAINS DRINKIN
x
56
—
S
:
.
WATER PIPING/DRAIN-WASTE-VENT/
PLUMBING REVERSALS
wSrAuxnoPi,ALTERAITON,WALE.
REVERSALS
x
S6
N.‘'*—.
:lii:
SEWAGE E ECTORSGRINDER,
SUMP PUMP
.:
WATER USING DEVICES
ICE AND/OR OOPFEE WAXER.
HOSE LLA, STEAMER, PROOPER,
CARBONATOR, SWAMP COOLERS
.:
CROSS -CONNECTION DEVICES
VACUUM BREAKER. CL LECK VALVE.
AND RP B.P.D. FOR: VATS, SUMPS,
ANKS, BOILERS, !t SPRINKLER SYSTEMS
INTERCXPTORS
GREASE TRAP. SAND TRAP.
CHEMICAL HOLDING TANK
: e
E
NLTROUS, OXYGEN ,
x
S6
—
5
MISCELLANEOUS FIXTURES
x
S6
Method
of Payment:
•
Subtotal
/i
PLUS: PROCESSING PEE
525.00
Z•71
'''
Q
r
tts::cu
❑
owl
o o
TOTAL PERMIT FEE DUE
S R
0 Cash 0 Check
■
—
FAXED PERMIT WILL ONLY 11E ACCEPTED WW1 PAY (LWT OFA M4(JQR CREDIT CARD
Dau: Expires
::::: ::::: ' :::::::::.:::::: ' ::::. " " .•:•:::::::: .
:: '•I: A6E AKE. RhCKS:I'AY.XBLE .Q.::::;
: PO ..*O* t1C�iP:4 0:`:C. 1' R :''•
BankcaudNumber:
Spokane County Division of Building Planning
1026 Wert Broadway Avenue * Spok.iw WA 99260
Tcl. No. (509) 456-3675 *Fax No. (509) 3243198 * TDD No. (509) 324.3166
1211 f/I) a we.VlNobpuwb