1999, 10-21 Permit App: 99010153 SewerProject Number. 990101 53 Inv: I�
A
a '
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 10/21/19 Page 1 of 1
Proiect Information:
.................. .
Permit Use: SEWER CONNECTION - DRY LINE ONLY
Setbacks: Front Left: Right:
Site Information:
Plat Key: 004049 Name: SILAS PLACE ADDITION
Rear:
Contact: CHD, INC.
Address: PO BOX 13717
C -Z SPOKANE, WA 99213
Phone: (509) 926-5229
District: H
Parcel Number: 45031.4903
SiteAddress: 4705 N SILAS RD Owner: Name: C H D INC
Spokane, WA USA 99216 Address: 0 PO BOX 13717
Location:: SPO SPOKANE, WA 99213-3717
Zoning: UR -3.5 Urban Residential 3.5
Water District: 001 TRENTWOOD Hold: 0
Area: 15,432 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information: IESNISMOMMISPRONSSMSOISSM
Department
UTILITIES
Comments:
Permits:
Review by Utilities C 99 -741 -Po{
u 7r (-17(C
Contractor: WES CROSBY
Address: P 0 BOX 13717
SPOKANE, WA 99213
Item Description
SEWER CONNECTION
PROCESSING FEE
Payment Summary:
Operator: RMB
Permit Type
Sewer Permit
Notes:
Sewer Permit
Finn: C H D INC
Phone: (509) 926-5229
Units Unit Desc
1 NUMBER OF
1 Y OR BLANK
Permit Total Fees:
Fee Amount
$85.00
$15.00
$100.00
Printed By: RMB Print Date: 10/21/1999
Fee Amount Invoice Amount Amount Paid Amount Owing
5100.00 5100.00 50.00 5100.00
5100.00
5100.00
$0.00
5100.00
Spokane County Division of Utilities 1 _ /0 (53
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:
117v6 / s,/, Co
City: ,_)""
Dry Lin
Sewer?
Zip: GIQZ /
Parcel number(ifknown):
Owner's name:
L
City/State: 5.,,.?G -cr 1-04
Zip: g'* zl 3
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):
Business address:
State contractor license number:
City/State:
Zip: Phone:
Contact Name:
Phone:
INTERIOR PLUMBING ALTERATIONS? (yes/no) circle one
Fill out the information in the table below i licable**
Contractor (if different from above): Phone:
Business Address:
City/State/Zip:
Fvr pluming ............... fee reformation, seeremorse side of tht �v�
FEE INFORMATION
Sewer Connection: Number of Buildings X(times) $100 (per bldg) = $
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 npt covered her col the County Division of Utilities @ 456-3604)
APPLICANT SIGNATURE:
Date: %G Z
Spokane County Division of Building & Planning
West 1026 Broadway Avenue * Spokane, Washington 99260
PHONE: (509) 456-3675 * FAX: (509) 324-3198 * TDD: (509) 324-3166
Return to:
Spokane County does not dtstsutynate on the bans of dtsabthty m the sdrrasnon to, or treatment or employment m, its programs or actnibes.
to/r4/Npt
r
PLUMBING PERMIT APPLICATrON
PROJECT ADDRESS:
OWNER:
PHONE: DAYTIME CONTACT
MAILING ADDRESS:
(street)
CONTRACTOR:
(city/state)
(Z1p)
LICENSE:
PHONE:
MAILING ADDRESS:
(street)
(city/state)
(zip)
PLUMBING FIXTURES
DESCRIPTION DETAIL
# OF
UNITS
MULTI-
PLIED BY
COST
/UNIT
EQUALS
AMOUNT
TOILETS
WATER CLOSETS, BIDETS
x
$6
$
Bi
URINALS
x
$6
$
TUBS
BATH, JACUZZI, SPA, GARDEN
x
$6
$i
SHOWERS (per trap)
BASE, STALL, ON-SITE BUILD
x
$6
$
13
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD (PREP/CULINARY/MEAT)
x
$6
$
DISHWASHER
x
$6
$
CLOTHES WASHER
x
$6
GARBAGE DISPOSAL/GRINDER
x
$6
WATER SOFTENER.
x
$6
ELECTRIC HOT WATER TANKS
(NOTE: if gas water tank, see mechanical)
x
$6
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
x
$6
$
ROOF DRAINS/OVERFLOW DRAINS
x
$6
$
FOUNTAINS, DRINKING
x
$6
WATER PIPING/DRAIN-WASTE-VEN
PLUMBING REVERSALS
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
x
$6
SEWAGE EJECTORS
GRINDER, SUMP PUMP
x
$6
$
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLERS
x
$6
$
CROSS -CONNECTION DEVICES
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, SUMPS,
TANKS, BOILERS, & SPRINKLER SYSTEMS
x
$6
$
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
x
$6
$
MEDICAL GAS (per outlet/bottle station)
NITROUS, OXYGEN
x
$6
$
MISCELLANEOUS FIXTURES
x
$6
$
NOTE: MINIMUM PERMIT FEE IS $35.00
❑ RESIDENTIAL ❑ COMMERCIAL
SIGNATURE:
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE $
Spokane County Division of Building & Planning :€::i')I�IJ�Si>4EI47E><X'Kr€1lPIE::
1026 WBroadwayAvenueSpokane,WA 99260
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.
111/14/76 Vnastcriplumpam.hnd