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1996, 09-11 Permit App: 96007689 Sewer'7)J_G C; SEWER CONNF,CTION 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: Dry Line Owner's name: �n/,Lz � ct—1 Sewer? (Yf/lY�i 1jl.C.i_° �A PA1. f-6 Vev7J Cit A Y:',�.✓yw City/State: Zip: Zip: Parcel number (if known): L S Phone: . a 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:enc— I �t / Zip:___g `L l� Phone: GP State contractor license number: Utilities installers permit number: INTERIOR PLUMBING ALTERATIONS? (yes/(ri,lcircleone Fill out the information in the table below if applicable**'- Contractor (if different from above): Phone: 2A - Cl C) 8 6 Business Address: Cit ate/Zip: 1 `1[614ti C.4 r e CO CL r -5 vJA q q o FEE INFORMATION Sewer Connection: Number of Buildings �_ X (times) $50 (per bldg) = $ 1-1 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 i 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: 1'1 Spokane County Division of B ildings 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. V251% caw wwd4�.va PROJECT ADDRESS: OWNER: MAILING ADDRESS: PLUMBING PERMIT APPLICATION PHONE: DAYTIME CONTACT (street) (city/state) (zip) CONTRACTOR: _P_ f , r- J, t Jn �1 n <,r1 n D I t r nn 1A I n i'x LICENSE:. D n a 1% PHONE: MAILING ADDRESS: Iq rj �I� Cn an r 1-S NA Q D (street) (city/state) (zip) 'rel. No. (509) 456-3675 • Fax No. (509) 324-3198 • TDD No. (509) 324-3166 Spokane County does not discriminate on the basic of disability in the admission to, or treatment or employment in, its programs or activities. PLUMBING FIXTURES DESCRIPTION DETAIL OFwcnCOST UNITS - nmDsy XNIT u,w AMOUNT B02 TOILETS WATER CLOSETS, BIDETS x S6 = S B03 URINALS — x S6 = S B04 TUBS BATH, JACUZZI, SPA, GARDEN x $6 = S BO$ SHOWERS per trap BASE, STALL, ON—SITE BUILD x $6 = $ B06 SINKS IAVS/BASINS,HAP, FLOOR, KITCHEN, LAUNDRY, UTILITY. JANITOR PHOTO, X—RAY, FOOD REP/CULINARY/MEA x $6 = S B07 DISHWASHER - x S6 = S CLOTHES WASHER - x $6 = S 1309 GARBAGE DISPOSAUGRINDER - x S6 = $ B1 WATER SOFTENER - x S6 = S B11 ELECTRIC HOT WATER TANKS (NOTE: if gas water tank, see mechanical) x $6 = S B12 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE x $6 = S BL ROOF DRAINS/OVERFLOW DRAINS ca - x $6 = B14 FOUNTAINS, DRINKING - x $6 = S B15 WATER PIPING/DRAIN -WASTE- VENT/ PLUMBING REVERSALS INSTALLATION ALTERATION, REPAIR, REVERSALS x $6 = S B16 SEWAGE EJECTORS GRINDER SUMP PUMP x $6 = S B17 WATER USING DEVICES ICE AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLERS x $6 = S B18 CROSS-CONNECI'IONDEVICES VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, SUMPS, TANKS, BOILERS, & SPRINKLER SYSTEMS x $6 = S B19 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK x $6 = S B20 MEDICAL GAS per outlet/bottle station NMOUS, OXYGEN x $6 = S 1321 MISCELLANEOUS FIXTURES x S6 = $ NOTE: MINIMUMPERMIT FEE IS $35.00 SIGNATURE: Spokane County Division of Buildings 1026 W. Broadway Avenue • Spokane, WA 99260 Subtotal PLUS: PROCESSING FEE $2$.00 TOTAL PERMIT FEE DUE $ PLEASE MAKE CHECKS PAYABLE T SPOKANE COUNTY PERMIT CENTER 'rel. No. (509) 456-3675 • Fax No. (509) 324-3198 • TDD No. (509) 324-3166 Spokane County does not discriminate on the basic of disability in the admission to, or treatment or employment in, its programs or activities.