1996, 09-11 Permit App: 96007692 SewerJ� C 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 fair, 12 months from the date of issuance. No
extensions will be granted.
PROJECT INFORMATION
Job_address:I Dry Line I Owner's name: J'U
\j .�ani.A�l C'' Sewer? (Y N� �J
City::. City/State:
Zip: J ( Zip:
Parcel number (if known):
Phone:
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):
Business address:
City/State:__' 6j_� C I \V 1
Zip: CAGt `L nL, Phone: 2.(�- � G (czL
State contractor license number: .
Utilities installers permit number:
INTERIOR PLUMBING ALTERATIONS? (yes/64 circle one
Fill out the information in the table below if applicable**
Contractor (if different from above): Phone: 2. r1 - C1 C38 6
Business Address: Cit ate/Zip:
FEE INFORMATION
Sewer Connection: Number of Buildings X(times) $50 (per bldg)
TOTAL FEE
* One permit required for each separate building, shop, garage, etc., that will be connected to the sewer.
* Condos, townhouses, & 2- 3- and 4 plexes require 1 permit per address/stub.
*Multiple buildings (apartments, industrial complexes) require I permit per building.
(For situations not covered here, call the County Utilities Division @ 456-3604)
APPLICANT SIGNATURE: > , �" �� Date: l
j•
f Spokane County Divisio of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260
PHONE: (509) 456-3675 * FAX: (509) 324-3198 * TDD: (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.
Vass a\, t—d4.w pik
PROJECT ADDRESS:
OWNER:
MAILING ADDRESS:
CONTRACTOR:
PLUMBING PERMIT APPLICATION
PHONE: DAYTIME CONTACT
(street) (city/state) (zip)
LICENSE:.
PHONE.
MAILING ADDRESS: Iq S2-0 t� (p4-1 L� (` r� ac 1^ S VV IA a Q c� I
(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.
PLUMBINGFIXTURES--COST
DESCRIPTION DETAIL
UNITS
ruanarr
NIT
u.
AMOUNT
B02
TOILETS
WATER CLOSETS, BIDETS
x
$6
=
$
.
URINALS
—
x
$6
=
$
1304
TUBS
BATH, JACUZZI, SPA, GARDEN
x
$6
=
$
B051
SHOWERS per trap
BASE, STALL, ON—SITE BUILD
x
$6
=
$
B06
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR PHOTO,
X—RAY, FOOD REP/CLUNARY/MEA
x
$6
=
$
B07
DISHWASHER
-
x
$61
=
$
CLOTHES WASHER
-
x
$6
=
$
B09
GARBAGE DISPOSAUGRINDER
-
x
$6
=
$
B1
WATER SOFTENER
-
x
$6
=
$
BI I
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank see mechanical)
x
$6
=
$
B12
FLOOR DRAINS
AREA, CASE, COII, TRENCIL CONDENSATE
x
$6
=
$
B1.
ROOF DRAINS/OVERFLOW DRAINS ea.
—
x
$6
=
$
Bl
FOUNTAINS, DRINKING
-
x
$6
=
$
B15
WATER PIPING/DRAIN —WASTE— VENT/
PLUMBING REVERSALS
INSTALLATIOKALTERATION, REPAIR,
REVERSALS
x
$6
=
$
B16
SEWAGE EJECTORS
GRINDERSUMPPUMP
x
$6
=
$
B17
WATER USING DEVICES
ICE ANDl011COFFEE MAKER,
HOSE BIB, STEAMER PROOFER,
CARBONATOR, SWAMP COOLERS
x
$6
=
$
131
CROSS—CONNECTION DEVICES
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VAT$ SUMPS,
TAN" BOILERS, & SPRINKLER SYSTEMS
x
$6
=
$
131
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CEENUCAL HOLDING TANK
x
$6
=
$
B20
MEDICAL GAS per outlet/bottle station
NITROUS, OXYGEN
x
$61
=
$
1321
MISCELLANEOUS FIXTURES
I
x 1
$6
= Is
NOTE: MMMUMPERMIT FEE IS $35.00
SIGNATURE:
Spokane County Division of Buildings
1026 W. Broadway Avenue • Spokane, WA 99260
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
$
PLEASE MAKE CHECKS PAYABLETO
SPOKANE COUNTY PERMIT CENTER
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.