2000, 03-20 Permit App: 00001761 Sewer, Plumbing Reversal, Fixtures Spokane Count}:Divizion of Utilities
\*:):) SEWER CONNECTION PERMIT
APPLICATION O FORM �� 17�
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: i Dry Line Owner's name:
0 r7. E• %Iti / Sewer? (Yall
City: City/State:
Zip: Zip:
Parcel number(if known): 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): State contractor license number:
-TLC Co .�tal,1cri ok) l LCco iG 7Y1
Business address: Contact Name:
00(o Sa Hfr D Q
City/State:@ 1`�E IvE`-t (A) A-
Zip: q\q C Phone: Phone: R a-7-- (9-1(00
INTERIOR PLUMBING ALTERATIONS.0 no) did.
Fill out theinormation in the table below i lic' r : •
C tractor(if different above): Phone: q oW a- 15q/
oA Vom ab16W
Business Address: City/State/Zip:
ls(-{, I to ALK( Gk&MPt(IZES WA-96101 (o
For plumhing rrei+er�af fee r f�» r 3 exs i?Ce t of iiain.:
FEE INFORMATION
Sewer Connection: Number of Buildings / X(tines)$100(per bldg) _$h0 Q n
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 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 Utilities @ 456-3604)
APPLICANT SIGNATURE: 41.,_ t. _ Date: 3- A6 - 0 C)
Return to:
Spokane County Division of Building dr Planning
West 1026 Broadway Avenue*Spokane, Washington 99260
PHONE: (509)456-3675 *FAX:(509)324-3198*TDD:(509)324-3166
Spokane County don not discriminate en the bass of drnbdtty to the a:rn:oon to,or treatment or employment in,its programs or activities
a
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS: /0 if ().S F, _ch 4 k f
OWNER: PHONE:DAYTIME CONTACT
MAILING ADDRESS:
(street) (city/state) (zip)
CONTRACTOR: �� GO IV'–� i LL it j j I = LICENSE: 6ESr(,22.)P*08 84/j T
ALK
MAILING ADDRESS: I 8C( Cr, C--- , AL\< ( C-_-)0_C-C=IU ci kJA- 990/ CD
(street) (city/state) (zip)
—
PLUMBING FIXTURES #OF Munn- COST
DESCRIPTION DETAIL UNITS PLIED 1W /UNIT EQUALS AMOUNT
B#J < TOILETS WATER CLOSETS,BIDETS x $6 = $
lipURINALS x $6 = $
O4<:TUBS BATH,JACUZZI,SPA,GARDEN X $6 = $
13:95:'SHOWERS(per trap) BASE,STALL,ON-SITE BUILD X $6 = $
&06 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN, X $6 = $
LAUNDRY,UTILITY,JANITOR,PHOTO,
X-RAY,FOOD(PREP/CULINARY/MEAT)
$f5 ` DISHWASHER - x $6 = $
Aliti CLOTHES WASHER - x $6 = $
3z GARBAGE DISPOSAL/GRINDER - x $6 = $
° o:'WATER SOFTENER - x $6 = $
gig ELECTRIC HOT WATER TANKS (NOTE: if gas water tank,see mechanical) x $6 = $
H :FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6 = $
01411 ROOF DRAINS/OVERFLOW DRAINS - x $6 = $
an FOUNTAINS,DRINKING - x $6 = $
WATER PIPING/DRAIN-WASTE-VEN INSTALLATION,ALTERATION,REPAIR, j X $6 = $ /
l PLUMBING REVERSALS REVERSALS / G - ----
016i SEWAGE EJECTORS GRINDER,SUMP PUMP X $6 = $
k ,WATER USING DEVICES ICE AND/OR COFFEE MAKER, x $6 = $
`,`''''''`^' HOSE BIB,STEAMER,PROOFER,
.:0,:•:•:•:•:,,,,
'`''` CARBONATOR,SWAMP COOLERS
t <CROSS-CONNECTION DEVICES VACUUM BREAKER,CHECK VALVE, x $6 = $
'''`'ii i. , AND ILP.B.P.D.FOR VATS,SUMPS,
TANKS,BOILERS,&SPRINKLER SYSTEMS
gft INTERCEPTORS GREASE TRAP,SAND TRAP, x $6 = $
CHEMICAL HOLDING TANK
fag MEDICAL GAS(per outlet/bottle station)Nanous,OXYGEN x $6 = $
EMS '.MISCELLANEOUS FIXTURES X $6 = $
NOTE. MINIMUM PERMIT FEE IS$35.00 Subtotal
PLUS: PROCESSING FEE $25.00
RESIDEN IAL ❑ COMIVIE' IAL TOTAL PERMIT FEE DUE $ '3t.1 00
:•t::Y;:;yi :m':i: f::ii:jGii::iiiiiiiiiiii:r.......n......
SIGNATURE:G TUBE•
sA < ttr . 'E;?`AB `:.,
::i}::�:Fti>.::ij:
Spokane County Division of Building& Planning :.:< PO; ECOUNTY .F mpltooT R.E«.
1026
W. Broadway
Avenue
Spokane, V
A 99260
.
Tel. No. 509 4
-
56
( )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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