HomeMy WebLinkAbout1996, 09-11 Permit App: 96007690 SewerSEWER 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 for 12 months from the date of issuance. No
extensions will be granted.
PROJECT INFORMATION
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Job address: Dry Line Owner's name: f.rn.�liNt,
. 1r n� C•� Sewer? (Yq
City: rg City/State: e
Zip: "—I Zip: 6f
Parcel number (if kno"): 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: , 1 A /
Zip: 9 C4 `L <1 L, Phone: �i_l 2.1 c, (21—i
State contractor license number:
Utilities installers permit number:
INTERIOR PLUMBING ALTERATIONS? (yeS�Vo) circle one
Fill out the information in the table below if applicable
Contractor (if different from above): Phone: 2,r1 - C1 O �3 6
Business Address: Cit ate/Zip:
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FEE INFORMATION
Sewer Connection: Number of Buildings _ X (times) $50 (per bldg) _ $ 56, 0 C�
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 addressistub.
*Multiple buildings (apartments, industrial complexes) require I permit per building.
(For situations not covered here, call the County Utilities Division @ 456-360.4)
APPLICANT SIGNATURE: ,� Date: Zf ;, -
r Spokane County Division 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.
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PLUMBING PERMIT APPLICATION
PROJECT ADDRESS: +
OWNRIZ:
MAILING ADDRESS:
CONTRACTOR:
PHONE: DAYTIME CONTACT
(street) (city/state)
(zip)
PHONE:
MAILING ADDRESS: (r] s i n re' t' n Ar r WA a g p l +
(street) (city/state) (zip)
`"TOILETS
WATER CLOSETS BIDETS
x
ab
= 13i
URINALS
-
x
$6
=
$
TUBS
BATH, JACUZZI, SPA, GARDEN
x
$6
=
$
SHOWERS per trap)
BASE, STAU., ON—SITE BUILD
x
$6
=
$
7
SINKS
LAVS/BASINSBAR, FLOOR. KITCHEN.
LAUNDRY, UTILITY, JANITOR PHOTO,
X—RAY, FOOD PICUL.INAR IMSA
x
$6
=
$
.
DISHWASHER
-
x
$6
=
S
CLOTHES WASHER
-
x
$6
=
S
GARBAGE DISPOSAUGRINDER
-
x
S6
=
S
Bl:
WATER SOFTENER
-
x
$6
=
S
Bl l
ELECTRIC HOT WATER TANKS
OTE: if las water tank, see mechanical)
x
$6
=
$
131'
FLOOR DRAINS
AREA, CASE, COH,TRENCH. CONDENSATE
x
$6
=
S
BI
ROOF DRAINS/OVERFLOW DRAINS ea
-
x
$6
=
S
B1
FOUNTAINS, DRINKING
-
x
$6
=
S
WATER PIPING/DRAIN-WASTE-VENT/
PLUMBING REVERSALS
INSTAUATIOKALTERATION,REPAIR.
REV RSAM
x
S6
=
S
B16
SEWAGE EJECTORS
GRINDER SUMP PUMP
x
$6
=
S
BI1
WATER USING DEVICES
ICE AND/OR COFFEE MAKER
HOSE BIK STEAMER PROOFFR.
CARBONATOR, SWAMP COOLERS
x
S6
=
S
B1
CROSS—CONNECTION DEVICES
VACUUM BREAKER CHECK VALVE,
AND R.P.B.P.D. FOR: VATS SUMPS,
TANKS BOILERS, & SPRINKLER SYSTEMS
x
$6
=
S
B191
. INTERCEPTORS
GREASE TRAP, SAND TRAP,
x
$6
=
S
MEDICAL GAS(per outle0ottle station NTTROUS,OXYGFN
MISCELLANEOUS FIXTURES
NOTE: MflVBWLMPE JW7T FEE IS $35.00
SIGNATURE:
x = 3
x $6 = $
Subtotal
S: PROCESSING FEE
AL PERMIT FEE DUE $
Spokane County Division of Buildings >�rvr►t�a vuvi. a a. r a.a.�.., ..�..�
•
1026 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.