1999, 04-02 Permit App: 99002597 Sewer, Plumbing ReversalSpokane County Division of Utilities
SEWER 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
Job address:
/3a/ P,'eree-
City:coo M? , G�
Zip: 9,* 0(
Parcel number (if known):
Dry Line
Sewer? (.(31
Owner's name:
City/State:20/Tg72r�
Zip: 9 �O
Phone:
7rr7 ,jLve�S
First-time contractors or home -owners performing the installation must first
[456-3604]) before a permit can be issued O'S .
Name of Utilities Division person contacte
CONTRACTOR INFO
contact the utilities department (in person or via phone
4- Z - 'lal
TION
Contractor (company name):
State contractor license number:
Business address:
City/State:
Zip: Phone:
Contact Name:
Phone:
INTERIOR PLUMBING ALTERATIONS?
Fill out the information in the table below if applicab
circle one
Contractor (if different from above): Phone:
Business Address: City/State/Zip:
**Fnfpfumbin :revematfee mforxsa ger. verses▪ 't�rrsfr�rtivii: ,
FEE INFORMATION •
Sewer Connection: Number of Buildings 1 X owes) $100 (per bldg) = $ nt
TOTAL FEE
• For a single-family residential unit, one permit is required;
• For a condominium, townhouse, duplex, triplex or fourpler with separate ownership (as determined by lot lines) separate
address and 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 Ut lib's ® 456-3604)
Date: 9/2 /� 9
APPLICANT SIGNATURE:
Rerun to:
Spokane County Divine' of Buil ins dr Plannurg
(Wert 1026 Broadway Aunnre 't Spokane, l atinrgton 99260
PHONE (509) 456-3675 * FAX (509) 324-3198 * TDD: (509) 324-3166
;pokant County de.N not b unntao 011 m0 0W et'dnninktr 10 die adenumYn 1. of Q.1111.e4 at ; Y p[•armI of RCtia
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER:
MAILING ADDRESS:
CONTRACTOR:
e kr-Ce
(street)
PHONE: DAYTIME CONTACT
C
(city/state)
(zip)
LICENSE:
PHONE:
MAILING ADDRESS:
(street)
(city/state)
(zip)
1026 W. Broadway Avenue Spokane, A
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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PLUMBING FIXTURES
DESCRIPTION DETAIL
# OF
UNITS
MUt.Tt-
rueDaY
COST
/UNIT
£QUAts
AMOUNT
302
TOILETS
WATER CLOSETS. BIDETS
X
$6 =
$
B03<
URINALS
-
x
$6 =
$
E04.
TUBS
BATH, JACUZZI, SPA, GARDEN •
X
$6 =
$
305
SHOWERS (per trap)
BASE. STALL. ON-SITE BUILD
X
$6 =
$
B06
SINKS
LAVS/BASrNS. BAR FLOOR. KITCHEN.
LAUNDRY. UTILITY. JANITOR. PHOTO.
X-RAY, FOOD (PREP/CULINARY/MEAT)
x
$6 =
$
307,
DISHWASHER
-
x
$6 =
$
BOS:
CLOTHES WASHER
-
x
$6 =
$
B09
GARBAGE DISPOSAL/GRINDER
-
x
56 =
$
131:0
WATER SOFTENER
-
x
$6 =
$
31.1:
ELECTRIC HOT WATER TANKS
(NOTE if gas water tank. see mechanical)
X
$6 =
$
BIZ:
FLOOR DRAINS
AREA, CASE, COIL. TRENCH, CONDENSATE
X
$6 =
$
BIT
ROOF DRAINS/OVERFLOW DRAINS
.
x
$6_ =
$
314
FOUNTAINS, DRINKING
.
x
$6 =
$
BIS
WATER PIPING/DRAIN-WASTE-VEN
PLUMBING REVERSALS
INSTALLATION, ALTERATION, REPAIR
REVERSALS
x
$6 =
$
316
SEWAGE EJECTORS
GRINDER SUMP PUMP
X
$6 =
$
BI7
WATER USING DEVICES
X
$6 =
.
$
ICE AND/OR COI- t•taMAKER.
HOSE BIB, STEAMER.. PROOFER.
CARBONATOR. SWAMP COOLERS
AI$
CROSS -CONNECTION DEVICES
vacuum BREAKER. aim( VALVE,
AND R.P.B.P.D. FOR VATS, SUMPS.
TANKS, BOILERS. & SPRINKLER SYSTEMS
x
$6 =
$
81>3
INTERCEPTORS
GREASE TRAP. SAND TRAP.
CHEMICAL HOLDING TANK
X
$6 =
$
320;:
MEDICAL GAS (per outlet/bottle station)
NITROUS. OXYGEN
X
$6 =
$
321-
MISCELLANEOUS FIXTURES
x
$6 =
$
Spokane
NOTE: MINIMUM PERMIT
❑ RESIDENTIAL ❑
SIGNATURE:
FEE IS $35.00
COMMERCIAL
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
$
€ LEA E 1C' Ai
.;:
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ABi.E TO
CountyDivision of Building &W Planning
:}.;;� �<`?N�
m,.:K..„n.:..,,,,;,:,,::.:::;:.:::
1026 W. Broadway Avenue Spokane, A
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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