2000, 03-14 Permit App: 00001595 SewerSpokane County Division of Utilities
SEWER CONNECTION PERMIT 0 } SSG
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 dale of issuance. No extensions will be granted.
PROJECT INFORMATION
Job address
City: .S
Zip: 99a /G,
Parcel number(irknown):
Dry Line
Sewer? (l
Owner's name:
City/State: A0 /741c LJa, V
Zip: q -9a) 6
Phone: 9a
First -lime 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):
H &. C -T t Ni
State contractor license number:
H.713C-C) lv k* -1- 5 K4=
Business address:
Il t'i ei. \)P-t.LE-w.a-- PcVF
City/State:----3;,-)C) I_A-& C . (S-
Zip:
S
Zip: uric -CC.") Phone: C)<{lr •n.(r (4
Contact Name:
Phone:
INTERIOR PLUMBING ALTERATIONS? (ye
Fill out the information in the table below if applicable*
Contractor (if different,from above):
Business Address:
f, C:, &c l31%n
Phone: 934c-
City/State/Zip:
3 (c-
le one
City/State/Zip:
5„()k.tkt�t.1_ (A) 4 ciciiaS7
*t For plumbing reversal fee information,.see re -verse side of this forth-
"-
FEE
orts-
FEE INFORMATION
Sewer Connection: Number of Buildings / X (times) $100 (per bldg) = $ /(7O,00
TOTAL FEE
• For a single-family residential unit, one permit is required;
• For a condominium, townhouse, duplex, triplex or fourplex with separate ownership (as determined by lot lines) separate
address end separate stub, one permit is required per address per stub;
• For a single building duplex, triplex or fourplex with single ownership, one permit is required
• Multiple buildings (apartments, industrial complexes) with single ownership, one permit required per building connecting to
the sewer.
(For situations not covered here, call the County Division of Utilities @ 456-3604)
APPLICANT SIGNATURE. j(J t/n
Date: 3 -- /y_ D d
Return to:
Spokane Couney Division of Building & Planning
(Gest 1026 Broadway Avenue ' Spokane, It%ashinglon 99260
PHONE- (509) 456-3675 ` FAX: (509) 324-3198 * TDD- (509) 324-3166
Spokane County does not d,smmnra,e r.. -.e —.us o:.s.:_: r._ a.-sm... ., o.veatamm�< -,p loymm,m,its pm„,ams o, suvmea
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER:
PHONE: DAYTIME CONTACT
MAILING ADDRESS:
(street)
CONTRACTOR: t) A O�t2 6 j
MAILING ADDRESS: ) U , 1_)0% 1007 SPok.Fri\
street
(city/state)
(Zip)
LICENSE: 3L}GKJP*(3JbN 3
PHONE: q U Cs - / O
LOA- (21 33`7
(city/state) (zip)
Tel. No. (509) 456-3675 * Fax No. (509) 324-3198 * TDD No. (509) 324-3166
Spokane County docs not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities.
I nq 4)964nasicMlumpenn hnd
PLUMBING FIXTURES
DESCRIPTION DETAIL
# OF
UNITS
htut.n.
PUEDBY
COST
/UNIT
EQUALS
AMOUNT
BA2
TOILETS
WATER CLOSETS, BIDETS
x
$6
=
$
B03:
URINALS
-
x
$6
=
$
BO
TUBS
BATH, JACUZZI, SPA, GARDEN
X
$6
=
$
O5:
SHOWERS (per trap)
BASE, STALL, ON-SITE BUILD
X
$6
=
$
B06'.
SINKS
LAVS/BASINS, BAR FLOOR KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD (PREP/CULINARY/MEAT)
X
$6
=
$
BU7
DISHWASHER
-
x
$6
=
$
BCI$:
CLOTHES WASHER
-
x
$6
=
$
809.:
GARBAGE DISPOSAL/GRINDER
-
x
$6
=
$
B.L(I:
WATER SOFTENER
-
x
$6
- =
$
B.I'lL:
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank, seemechaniw0
X
$6
=
$
tiOFLOORDRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6
=
$
813:.
ROOF DRAINS/OVERFLOW DRAINS
-
x
$6
=
$
814
FOUNTAINS, DRINKING
-
x
$6
=
$
BIS'
:::.
WATER PIPING/DRAIN-WASTE-VEN
PLUMBING REVERSALS
INSTALLATION, ALTERATION, REPAIR
REVERSALS
X
• $6
=
$
BI6:
SEWAGE EJECTORS
GRINDER, SUMP PUMP
x
$6
=
$
BIT:
WATER USING DEVICES
ICE AND/OR COFFEE MAKER
HOSE BIB, STEAMER PROOFER
CARBONATOR SWAMP COOLERS
X
$6
=
$
BI:$'CROSS-CONNECTION
DEVICES
VACUUM BREAKER, CHECK VALVE,
AND RP.B.P.D. FOR: VATS, SUMPS,
TANKS, BOILERS, & SPRINKLER SYSTEMS
x
$6
=
$
3j9:
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6
=
$
OS:
MEDICAL GAS (per outlet/bottle station)
NITROUS, OXYGEN
X
$6
=
$
D2,i
MISCELLANEOUS FIXTURES
x
$6
=
$
Spokane
Ifl (
NOTE: MINIMUM PERMIT FEE IS $35.00
❑ RESIDENTIAL 0 COMMERCIAL
SIGNATURE:
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
$
'`.:.
`PT::tASE MOKE CEtCKS.-YA Lt TcY':
CODUN4TY:PER,flT5.CENNTER°':<:''
- : - :i .
County Division of Building & Planning,SPOKANE
W Renadwnv Avenue * Snnkane. WA 99260
Tel. No. (509) 456-3675 * Fax No. (509) 324-3198 * TDD No. (509) 324-3166
Spokane County docs not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities.
I nq 4)964nasicMlumpenn hnd
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