1999, 12-21 Permit App: 99012075 SewerSpokane Coudty Ihvision of Utilities
SEWER CONNECTION PERMIT
APPLICATION FORM
cr 15
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:
A)
61/ Ft s
City: /o
Zip: q/.1 v 4r
Parcel number (if known):
Dry Line
Sewer? (YIN)
Owner's name:
-71-2 k et�Liz5
City/State:
Zip: •
Phone:
First-time contractors or home -owners performing the ins allation must first contact the utilities department (in person or via phone
[456-3604J) before a permit can be issued _
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Contractor (company name):
/kJi o c 24'iet)
Business address:
.02 tioA)in/ DtJJ1
City/State: dr-c-e.J ,test S
Zip: 9`14/6 Phone: /12 / —(�6
State contractor license number:
AL-tits/5144- 4 i 9 D'C
Contact Name:
To /22 .Te
Phone: .12/-/org
INTERIOR PLUMBING ALTERATIONS? (yes/no) Gavle one
Fill out the information in the table below if applicable**
Contr�1aCtor (if different from above): Phone:
-en, c 4 gjE/2
Business Address:
City/State/Zip:
For plumbing reversalfee-information, see re
rse side of thisform. _ '
FEE INFORMATION
Sewer Connection Number of Buildings / X(times) $100 (per bldg) = $ /4 0
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 Divisio
APPLICANT SIGNATURE:
tilities @ 456-3604)
te: /12/ /
Return to:
Spokane County Dibinon of Building dr Planning
Ir est 1026 Broadway Avenue • Spokane, Washington 99260
PHONE: (509) 456-3675 " FAX: (509) 324-3198 " TDD: (509) 324-3166
Spokane County don not chsmmnate on the basis of d'abthty m the admmon m, os treatment or enploymemt e4 Its pto®nu en actoteet
10/11/01 awnavt mane
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER:
PHONE: DAYTIME CONTACT
MAILING ADDRESS:
(street)
CONTRACTOR:r_c
(city/state)
(Zip)
MAILING ADDRESS:
LICENSE:
PHONE:
(street)
(city/state)
(zip)
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.
nvimov .n& isivt .a h.d
PLUMBING FIXTURES
DESCRIPTION DETAIL
# OF
UNITS
MULTI.
rueow/
COST
/UNIT
EQUAIS
AMOUNT
B02'
TOILETS
WATER CLOSETS, BIDETS
/
x
$6
=
$
80
URINALS
-
x
$6
=
$
B04::
TUBS
BATH, JACUZZI, SPA, GARDEN
X
$6
=
$
B05
SHOWERS (per trap)
BASE, STALL, ON-SITE BUILD
/
X
$6
=
$
B06 -
SINKS
LAVS/BASINS, BAR FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR. PHOTO.
X-RAY, FOOD (PREP/CULINARY/MEAT)
I
X
$6
=
$
B07'
DISHWASHER
-
x
$6
=
$
th18
CLOTHES WASHER
- -
x
$6
=
$
809.
GARBAGE DISPOSAL/GRINDER
-
x
$6
=
$
B(0:
WATER SOFTENER-
-
x
$6
=
$
BO
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank, see mechanical)
X
- $6
=
$
812.
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
x
$6
=
$
813
ROOF DRAINS/OVERFLOW DRAINS
-
x
$6
=
$
Bit
FOUNTAINS, DRINKING
•
x
$6
=
$
BIS
WATER PIPING/DRAIN-WASTE-VEN
PLUMBING REVERSALS
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
I
x
$6
=
$
616.
SEWAGE EJECTORS
GRINDER, SUMP PUMP
x
$6
=
$
81:7:
WATER USING DEVICES
ICEAND/ORCOFFEEMAKER,
HOSE BIB, STEAMER PROOFER,
CARBONATOR, SWAMP COOLERS
X
$6
=
$
BIS
CROSS -CONNECTION DEVICES
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, SUMPS,
TANKS, BOILERS, & SPRINKLER SYSTEMS
X
$6
=
$
R19
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6
=
$
B20
MEDICAL GAS (per outlet/bottle station)
NITROUS, OXYGEN
x
$6
=
$
B2I,,
MISCELLANEOUS FIXTURES
x
$6
=
$
Spokane
1026
NOTE: MINIMUM PERMIT FEE IS $35.00
❑ RESIDENTIAL 0 COMIMERCIAL
SIGNATURE:
Subtotal
PLUS: PROCESSING FEE
$25.00 -
TOTAL PERMIT FEE DUE
$
tASE;IYIAIEC1
' SPOKAiNE.COUN'FY
`
IS PAYABI:."I'.U.:'a.
FEBMIT
'i ''
CENTER'::'
,T-' ''�� �
County Division of Building & Planning
W. 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.
nvimov .n& isivt .a h.d