1996, 09-11 Permit App: 96007691 SewerSEWER CONNECTION PERMIT
APPLIC i TION 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: 1,� Dry Line Owner's name: �,��7,;�„�� Q J,!
Sewer? (Y(/N�)
City:
Zip: 4( ,2
Parcel number (if known):
City/State:
Zip:
Phone:
j ..
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:
Zip: Phone:
State contractor license number:
Utilities installers permit number:
INTERIOR PLUMBING ALTERATIONS? (yes/ oPcircleone
Fill out the information in the table below if applicable**
Contractor (if different from above): Phone: q 2A - C1 O �3 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 I permit per address/stub.
* Multiple buildings (apartments, industrial complexes) require 1 permit per building.
(For situations not covered here, call the County Utilities Division @ 456-3604)
APPLICANT SIGNATURE: y,• f,,; Date: ? I
Spokane County Division,Zf Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260
PHONE: (509) 456-3675 * FAX: (509) 324-3198 * TDD: (509) 324-3166
IC I(,,
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities.
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PLUMBING PERMIT APPLICATION
'ROJECT ADDRESS:
OWNER: (PHONE: DAYTIME CONTACT
MAILING ADDRESS:
CONTRACTOR:
(street) (city/state) (zip)
PHONE:
MAILING ADDRESS: Irl S 2-0 (e 4-" C� (� (�� (�(• 1' l S WA a Q o,
(street) (city/state) (zip)
TOILETS
WATER CLOSETS BIDETS
URINALS
-
TUBS
BATH JACUZZI, SPA, GARDEN
SHOWERS per trap
BASE, STALL, ON-SITE BUILD
SINKS
LAV S/BASIN$ BAR FLOOR KITCHEN.
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD (PREP/CULINARYA4EA1
wnn-
x
$6
= S
x
$6
= S
x
$6
= $
x
$6
= S
x
S6
= S
BO
DISHWASHER
-
x 1
$6
= IS
CLOTHES WASHER
-
x
$6
=
S
GARBAGE DISPOSAUGRINDER
-
x
$6
=
S
B10
WATER SOFTENER
-
x
S6
=
S
Bl I
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank see mechanical)
x
S6
=
S
B12
FLOOR DRAINS
AREA, CASE, COIL, TRENCK CONDENSATE
x
$6
=
$
B1.
ROOF DRAINS/OVERFLOW DRAINS ea.
-
x
$6
=
S
B14
FOUNTAINS, DRINKING
-
x
$6
=
S
B15
WATER PIPING/DRAIN -WASTE-VENT/
PLUMBING REVERSALS
iNsrALLATIOKALTERATION, REPAIR,
REVERSALS
x
$6
=
$
B14
SEWAGE EJECTORS
GRANDER SUMP PUMP
x
$6
=
S
B17
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER PROOFER,
CARBONATORSWAMP COOLERS
x
$6
=
S
B18
CROSS -CONNECTION DEVICES
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, SUMPS,
TANKS, BOILERS, dr SPRINKLER SYSTEMS
x
$6
=
S
B11
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
x
$6
=
S
B2
MEDICAL GAS per outlet/bottle station
NITROUS, OXYGEN
x
S61
=
S
13211
MISCELLANEOUS FIXTURES
x
$6
=
Is
NOTE: MINIMUMPERMIT FEE IS $35.00
SIGNATURE:
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
$
Spokane County Division of Buildings SPOKANE COUNTY YhKMII trL1y
1026 W. Broadway AvenueSpokane, 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.
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