HomeMy WebLinkAbout1994, 08-24 Permit App: 94008215 SewerSEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND
SIGNED OR PERMIT WILL NOT BE ISSUED.
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JOB ADDRESS : 7 O V / t'C ; Li LI , e ,./0-1)7-- PARCEL NUMBER:
(IF KNOWN)
CITY: 7/ ee.-6 STATE:______ - ZIP CODE:
ADDRESS : .-)-,/72.1...--2.
OWNER NAME:
CITY:
PHONE NUMBER:
Ai e
STATE: ZIP CODE:
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION�I�REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: U V, Il 7Y ,) fFX(',9*9 % /U ADDRESS:i''),2/.347N /37s
CITY: STATE: ZIP CODE:
PHONE NUMBER: g()(7 3 5 - 1 % ` (
0-7 5` CZ 3
STATE CONTRACTORS LICENSE NUMBER: V Cid
UTILITIES INSTALLERS PERMIT NUMBER: --N
INTERIOR PLUMBING ALTERATIONS? YES NO > (CIRCLE ONE)
INTERIOR ALTERATION BY:
ADDRESS:
CITY: STATE: ZIP CODE:
PHONE NUMBER:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION •# OF BUILDINGS / X 50.00 =
INTERIOR PLUMBING ALTERATIONS:# OF BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $
APPLICANT
SIGNATURE:
DATE:
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675