HomeMy WebLinkAbout1994, 10-04 Permit App: 94009773 Sewer 05/21/1993 04:20 509-9284306 RON SLOAN PAGE 01
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SEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY PND
SIGNED OR PERMIT WILL NOT BE ISSUED.
(IF KNOWN)
JOB ADDRESS : / �U 3 , ✓i� S� PARCEL NUMBER:
CITY: 5P&A-}tV STATE: 4` ZIP CODE: 9c7 /
OWNER NAME: 5;44--0-4=2-- ADDRESS
CITY: STATE: 4./4- ZIP CODE:
PHONE NUMBER:(Ajt . /Sr"e" 1))
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: AIv.lalADDRESS: .P.(). &hL. 1L�L5G,L
CITY: Ser11 fl/1� STATE:_ WA ZIP CODE: gA2,1�-1-
PHONE _ 1NUMBER: CI 2.2- @ S 'D
STATE CONTRACTORS LICENSE NUMBER: A L.v J A''A *- 1Q , p 5
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? NO (CIRCLE ONE)
INTERIOR ALTERATION BY:
ADDRESS: PHONE NUMBER:
CITY: -5-#4)e ,Q'41✓ STATE: leVn ZIP CODE: 992 /2
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION • # OF BUILDINGSX 50. 00 = re
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $ 4. -
APPLICANT
SIGNATURE: DATE:
SPOKANE COUNTY DEPT.. OP BUILDINGS
WEST 1026 BROADWAYAVENUE
SPOKANE, WA 99260 .4 777. C-
•
SANITARY- SEWER CONNECTION
PERMIT I N4c o 5
)RESS eo.1703 l21Y k Y f2zc E (Jj,'E INSP. D&TE 5.14•eS
4 BLOCK 3 ADDITION NEAT P4r2 s-r• ,4r�[��,
?(...673/ -14.04
cation of "Tee" or Tap
)e of Tap
le of Side Sever SCC �GVE�
)e of Building Sever
ith at Property Line
UM:
Vot2x 15Y: ViG, CKCAVATiNG
13Y: 1- 1
021J �L�(
By
Co. Utilities Dept.
Phone 456-3600