1996, 09-11 Permit App: 96007693 SewerSEWER CONNECTION PERMIT ��T
APPLICATION ,FORM
PLEASE NOTE: This application form must be f lled`out accurately and in its entirety, and signed, ora
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 I Owner's name:
i) �, 1, 3r,�►a,, !� Sewer? (i'Nl
City: ulkkt__ City/State:
Zip: 'A l t, 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:��{ 1C f �.Vt 1
Zip: c 1 `Ldd („ Phone: �1 )J, -"53 G (tet-{
State contractor license number:
"SKI-Y,_ 123 -VF'
Utilities installers permit number:
INTERIOR PLUMBING ALTERATIONS? Q!esjno) circle one
Fill out the information in the table below if applicable**
Contractor (if different from above): Phone: 2r1 - C1 ED z3 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 addressAtub.
*Multiple buildings (apartments, industrial complexes) require l permit per building.
(For situations not covered here, call the County Utilities Division @ 456-3604)
APPLICANT SIGNATURE:_/�_ ,
�?t�_ � ,�;~� � .�,_ Date:—
Spokane
aterSpokane County DivisioWof 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.
PROJECT ADDRESS:
OWNER
MAILING ADDRESS:
PLUMBING PERMIT APPLICATION
PHONE: DAYTIME CONTACT
(street) (city/state) (zip)
CONTRACTOR: LICENSE: A 0
PHONE:
MAILING ADDRESS: rj 2 (a4A, L�
(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.
I Rb97 r.wenpF,y. �. \d
PLUMBINGmu
DESCRIPTION DETAIL
I UNITS
n -
a.rBotrr
1UNIT
MQuA,.1AMOUNT
1302
TOILETS
WATER CLOSETS, BIDETS
x
$6
=
$
B0.
URINALS
-
x
$6
=
$
B04
TUBS
BATH, JACUZZI, SPA, GARDEN
x
$6
=
$
BO -51
SHOWERS per trap
BASE, StALI_ ON—SITE BUILD
x
$6
=
$
B06
SINKS
LAVS/BASINS BAR, FLOOR KITCIIEN,
LAUNDRY, UTII=, JANITOR, PHOTO,
X—RAY, FOOD REPICULINARY/MEA
x
$6
=
$
B07
DISHWASHER
-
x
$6
=
$
CLOTHES WASHER
-
x
$6
=
$
B09
GARBAGE DISPOSALIGRINDER
-
x
$6
=
$
131
WATER SOFTENER
-
x
$6
=
$
B11
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank, see mechanical)
x
$6
=
$
B12
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
x
$6
=
$
B13
ROOF DRAINS/OVERFLOW DRAINS ea
-
x
$6
=
$
B14
FOUNTAINS, DRINKING
-
x
$6
=
$
B15
WATER PIPING/DRAIN - WASTE- VENT/
PLUMBING REVERSALS
INSTALLATION. ALTERATION, REPAIR
REVERSALS
x
$6
=
$
131
SEWAGE EJECTORS
GRINDER SUMP PUMP
x
$6
=
$
B17
WATER USING DEVICES
ICE AND/OR COFFEE MAKER.
HOSE BIB, STEAMER PROOFTM,
CARBONATOR SWAMP COOLERS
x
$6
=
$
B18
CROSS—CONNECTION DEVICES
VACUUM BREAKER CHECK VALVE,
AND R.P.B.P.D, FOR: VATS, SUMPS,
TANKS, BOILERS, dt SPRINKLER SYSTEMS
x
$6
=
$
Bl
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL. HOLDING TANK
x
$6
=
$
B20
MEDICAL GAS per outlet/bottle station
NITROUS OXYGEN
I x 1
$6
=
S
B21
MISCELLANEOUS FIXTURES
I x 1
$6
=
$
NOTE: MINIMUMPERMIT FEE IS $35.00
SIGNATURE: A ^, /v�``
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 PAYABLE T
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.
I Rb97 r.wenpF,y. �. \d
11
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