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2000, 01-03 Permit App: 00000025 Sewer, Plumbing Fixtures Spokane County Division of Utilities SEWER CONNECTION PERMIT APPLICATION FORM 'LEASE NOTE: This application forst must be filled out accurately and in its entirety,and signed,or a permit will not be issued. Also note • hat sewer permits arc valid for 12 months form the date of issuance. No extensions will be granted. PROJECT INFORMATION oh address: Dry Line Sewer? Owner's name: q ' DrenD — —�� L'ity: Sp.is Prri i City/State: 5po 14/4w3 Ci 1.041- , Cie) (, Zip: 6c) 2c'(v . 'arcel Number(if known): Phone: '27 q �7J first-time contractors or home-owners performing the installation Hurst first contact the Utilities Division in person or via phone[456-3604])before a eemit can be issued. Name of Utilities Division person contacted: Q:fVEQ-5 CONTRACTOR INFORMATION ;ontractor(company name): Sate contractor license number: ALL-IEJD ta.g. s3ri12/a)G Co, Al.,LIESSO2S8/I Contact Name: usiness address: (1317 5, SEE /}1A'J ??12 , �,.n 141145 E4- 1 :icy/State: /Pl Et)I G/}I— 1-41-K.E,, 'QA Zip: q4 o Z2.-- Phone Number: (,SOLI, 1 q $,S g INTERIOR PLUMBING ALTERATIONS? no)circle one . • • Fill out the information in the table below if app icabk** Contractor(if different from above): Phone: $>GTct1151141c4- Business Address: City/State/Zip- CEg'4l G Pr_YL CJ124EiJ 14cgE6 / LOA, `-9401• 4 ?at . .... :"*Fo'r.pf'riiiibiiii evas"di fei<: iv»lsei�r`r�,sesr Al ME - _ � ".- (INFORMATION . ..,.,.• Sewer Connection: Number of Buildings 1 X(times)$100(per bldg) — S /DO—'70 TOTAL FEE For a single-family residential unit,one permit is required; For a condorniniurn,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 0456-3604) l'PLICANT SIGNATURE: (00...4-1.tsi-c% G , S r DATE: l ` 3 --• e pl etliod of Payment: Cash 0 Check 0 Visa ❑ MasterCard ❑ Discover Card • Date: Expires: Bankcard Number: Authorized Signature: • S: u:c County 1)ivisinn of 13uilding 3,c Planning c:t 11, oad way Avenue " Spokane \V/A 99260 4 , - •. . PLUMBING PERMIT APPLIC.A.1.10N- ,. .i.„. ,--.,, '••'.• • ,... .0 ..••s: .(,c ..:;,1;-.111•Alf.01-4"•,9•1'(-)I'i'';,);itil ViC):.) , ;'•:‘,/, •/•::./.k:. -,-.••• .: . •-...4 ECT ' . 'DRESS: USE% • Gt C.-\/ (2-5 A-i- AIMININCI . .<1,N ER: 6.: .. • . I. V‘IZ.4. • • • .... ,... PliONE (Daytime Contact): \ILING AUDI-LESS: ..---.A.• rr.1 ;,• )1. I• ..... ....__.—._........ ...... .- • ---1 01-i t q 6--. 61.4, 6 . • POK. ;LI /--(e0k5_11 .34-rDA-i qg i-°-& St rcct i. INTRACVOR: .. •• -- - ' v ....:f...r,,-‘ 1 •'•,'-',1-...... •. ... - . ILING ADDRESS: :L. •-. -,..,...:t,•,.;• •.•_..•i•4 %: . - .- ''''' P/IONE: .. . - -.:1131-1-1.p. ,. A.c,.K.I. • - • - Iga_.•-.1_51-0 _, . , . ..,. . ••. (/..,ea0/24c-RE5 l-0,4514, 510/(0 • r1 • I -.- -. • ' ' PLUMBING FixTunEs • . #oF mut.n. cosi . • tUtOUNT PLIED DESCRIPTION. DETAIL • . UNITS er UNIT. EQUALS .. TOILET'S ' WATER CLOSETS,BIDETS x • $6 •-, • - . ' URINALS x $6 -. ' • • TUBS BATT1,MU,ON-SITE BUILD x S6 i •• • , .• -. - StiOWERS(per trap) x • S6 2 ••• -_-_--- SINKS LA VS/BASINS,BAR,FLOOR, • ± . x . - . • • JANITOR,PHOTO,X-RAY.FOOD • •' '• '-‘'••• • :•.`.. •-•:‘•;;;••:." 1-3/...-...•.N, 1.-• • -. . • _. .. ... . . --.... • (PREP/CULINARY/MEAT' ' '• • ''- .: • • DISHWASHER - • , , - • _ _ " • • .4, CLOTHES WASHER : •-• • •• • j..dARBAGE DISPOSAJJGRIND ER S6 • ••• _ .• WATER SOFI- •ENER - . (NOTE.: if v4.•vist, ei•oplcisel 1; - ,,-,c',..:r iv.c..: ,l'..x-.,. • -.- •$6 . • .... . . . • . • xcal) ' ' ' " ' - ELECTRIC EIOT WATERTANRS mccItiAREA,CASE COIL,TRENCH:-----:•••.' •-'"" ' ..x • '•' $6 1• •• ,"• . • •• CONDENSATE . ' • • • . , FLOOR.DRAINS • • ..56 '...0..:........./••••• .'''' • .. .. RAINS/OVERFLOW DRAINS . 1 - • • - • • - •!..0•1 WINS,DRINKING . - . ; • . x ..• ' x • . $6 • '',... ' • . • PIPING/DRAIN-IN WASTE- - : INSTALLATION,ALTERATION. • . ,... •-•:•-x..-•- •--; :---, $6 ••...,••-••'-, . -!•• ' ' '. . . AG/PELEUMBJECTINOGRIstE,VERS,..„...ALS,4,_ . , .. . GREpRINADKER.REvEassumppul,47,0..7.7.:,..•....,-?:-:-; :-",•7•41:•i)....,•,••• '...1:;,:,.;,1%••.' •;•5-i,....\."., ;•.::••;:';'- .-'". 6/00 •• TER USING DEVICES .._. ,_ - ' OSS CONNECTION DEVICES ',.,_5'....) / • .vICAEcAuNuDm/OBREAR COKFEF:.EcHEMAKER,cc .,1. ).4. ,•,;........,:. ''-'x•''-. •• •.. $6 • -* ' HOSE BIB,STEAPROOFER,' ' i,..- •' ... ".":".I--:'. - 1....--2--5-11t,'...,..;••;::'-.72-'•-•-•::-----41. k. • •• . .. CA P130 NATOR,SWAMP COOLERS- ''' . '''"•'•' ' ..':'''''''.' " - . • • .. : - -; ----, ;•.. ' 2• \'A LVF.,AND R.P.B.P.D.FOR: • • • ' • • ,. .s'0,1,,i.,:r, i••••'-,'", "r(- • ' ...., '''•'" '*'' .....‘rr' . '• • • ••roi n /c VATS,SUMPS,TANKS,BOILERS,&.„, .,:,..,4,........,f; ,':;.:41:.•Cil`• 'I' f•'1 i?')..‘. ,I.''''%'*.: • . ..... : . ...- :'.4.1:J.i SPRINKLER SYSTEMs i',°."'.'')'1.•_ •.•.-. . • •• . . „,,„,,,„,,ts.r.'• :4 .—i.-•••••) '. *. •-• '1)'.AC(• : INTERCEPTORS-'.'-• `•-- •- GREASE TRAP,SAND TRAP, ....41.,4:„-4..r.- ;•f)*x;''' g'' 'i•$6 ,•.,.. „ . '?,,,,,. ./., ':.: ..7•14 •'. CHEMICAL HOLDING TANK • - •'% -'': ''''-' --""''''''' .."''''• ' •' . • . - .. ...MEDICAL GAS(per outlec/boctle sutiocil NITROUS,OXYGEN •. . . ,1 i f. • MISCELLANEOUS FL\TURES $6 - ;,,,..,.,... .("i',.:2 ` . '... '-•‘... • • - - • 'OD OP PAYMENT . . ' ._...__.. . ....___...___ SUBTOTAL ... . •-• . _ .. ..-- •• - • -- ' • '-it•I••1 _. - - • ....... ... ....--,. . . . Nimmi sli D CHECDIICOVER •. • . • • . .... . . ;:i..,.:•..:) vis..4 !..,1,421..1.m...f • , -,. ' PLUS PROCESSING FEE ":.'1'''' •S 25.00 K 0 ammism 0 . ' 0 ....:,:.-- FAXED rER_‘CTS‘11.1.°Nil"RE k C C Fi"a o toil(PAYVENT' ' . . .. TOTAL PERMIT FEE DUE •,..1/,-“Ir I ,/:'/•;';•3i--,0e, • EXTIS7-:, ARD NUMBERMINIMUMPERMIT FEE IS 535.00 PLEASE MAKE CHECKS PA YABLE TO : H- EI)SIC;NAlt F. -/ SPOKANE COUNTY PERMIT CENTER CLA‘. -El_ (2-• • '•••-•7"4-/5-1,....cy,e,t,..- ---U , witvDivis,cm(.1 Itis.1.1..ii:tc:.PI litnifl:'Olin': 1 '''''''t'-'si(‘ • I w J) A%.cttuc:,,StIoLlitc,WA 992(,0;005010 ic :,,..,-,. (1;,:d , . 7., • I“ N .•i2.4 INF, •'11)1)N. (,,(3,0 12 1166