2002, 03-25 Permit App: 02001888 Sewer, Plumbing FixturesSpokane Countypivisiosk.of Utilities
SEWER CONNECTION PERMIT APPLICATION FORM
oa- 6E6/
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 form the date of issuance. No extensions will be granted. A separate right-of-way permit is required for any work
performed in or from the county right-of-way.
PROJECT INFORMATION
Job Address:
Parcel Number.
Project Name:
ULID Name:
//455 N hlP
Lot:
Block:
CHECK APPLICABLE BOXES
❑ Regular
❑ Dry Sewer
❑ Repair
O Addition
O Abandonment
D Residential
0 Commercial
O Temporary
D New
D New
Owner's name:
Address:
L.:e4A.vy, -1,1-#-di h ti
City/State:
Zip:
Phone:
* FIRST TIME CONTRACTORS OR HOME OWNERS PERFORMING THE INSTALLATION MUST FIRST CONTACT THE
UTILITIES DIVISION BEFORE PERMIT(S) CAN BE ISSUED.
SIGNATURE OF UTILITIES DIVISION PERSON CONTACTED:
Contractor (company t ame):
/ T fi
Business address:
City/State:
Sex 4 -l✓
%Z10-,,-t,-1t4,ARpa--
Zip: 0/6
Sate contractor license number:
Contact Name:
Phone Number:
INTERIOR PLUMBING ALTERATIONS?
Fill out the information in the tab/e below if apple
circle one
Contractor (if different from above): Phone:
Business Address:
City/State/'Zip
**Forplumbing reversal fee information, see reverse side of Ibis form.
Number of Buildings connecting to sewer
FEE INFORMATION
X (times) $100 (per bldg) = S AO?) + S10.00 =
//.g
Ric lir Of \C'AY PERMIT
• For a single-family residential unit, one permit is required;
• Fora condominium, townhouse, duple, 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 budding connecting to the sewer.
(FOR SITUATIONS NOT COVERED HERE, CALL THE COUNTY DIVISION OF UTILITIES AT 477-3604)
Is any of the work to be performed in or from the county right-of-way? CT Yes No
APPLICANT SIGNATURE:
Method of Payment:
Leash 0 Check
0 Visa 0 MasterCard 0 Discover Card
DATE: .2
Date: Expires:
Bankcard Number:
Authorized Signature:
Spokane County Division of Building & Code I[nforccment
1026 West Broadway Avenue * Spokane WA 99260
Tel. No. (509) 477-3675 * Fax No. (509) 477-7198 * '11)1) No. (509) 477-7133
PLUMBING PERMIT APPLICATION
PROJECT
ADDRESS:
PERMIT
USE:
OWNER:
PFIONE (Daytime Contact):
MAILING ADDRESS:
(Street) (City/State) ("/.ip)
CONTRACTOR:
LICENSE:
MAILING ADDRESS:
PHONE:
(Street) (City/State) (Zip)
PLUMBING FIXTURES
DESCRIPTION
DETAIL
# OF
UNITS
MULTI-
PLIED
By
COST/
UNIT
EQUALS
AMOUNT
7
B02
TOILETS
WATER CLOSETS, BIDETS
/
x
$6
=
1303
URINALS
x
56
=
B04
'PUBS-
x
S6
=
B05
SHOWERS (per trap)
BATII, STALL, ON-SITE BUILD
/
x
S6
=
‘.
B06
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD
(PREP/CULINARY/MEAT
x
S6
=
B07
DISHWASHER-
x
56
=
B08 -
CLOTHES WASHER-
x
S6
=
B09
GARBAGE DISPOSAL/GRINDER-
x
S6
=
BIO
WATER SOI rENER
x
56
=
1311
li ECIRIC HOT WATER TANKS
(NOTE: if gas water tank see mechanical)
s
56
=
1312
FLOOR DRAINS
AREA, CASE, COIL 'IRENCII,
CONDENSATE
x
S6
=
B13
ROOF DRAINS/OVERFLOW DRAINS (ea.)-
x
56
=
B14
FOUNTAINS, DRINKING-
x
S6
=
B15
WATER PIPING/DRAIN-IN WASPE-
VENT/PLUMBING REVERSALS
INSTALLATION, ALTERATION,
REPAIR, REVERSALS/
x
$6
=
l
1316
SEWAGE EIEC'I'ORS
GRINDER, SUMP PUMP
x
S6
=
B17
WATER USING DEVICES
ICE. AND/OR COFFEE MAKER, HOSE
BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLERS
x
S6
=
1318
CROSS CONNECTION DEVICES
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR : VATS, SUMPS,
TANKS, BOILERS, & SPRINKLER
SYSTEMS
S6
=
1319
INTERCEPTORS
GREASE TRAP, SAND TRAP,
(:1 IEMICAL HOLDING TAN K
x
56
=
1320
MEDICAL. GAS (per outlet/bottle station)
NITROUS, OXYGEN
x
56
=
1321
MISCELLANEOUS FIXTURES
56
=
METHOD
0 C.ASII
DATE:
BANKCARD
AUTHORIZED
OF PAYMENT
MA
Alas/
: ❑
VTI 11 PAYMENT
CARD
SUB'l'O'I'A1.
L
PLUS PROCESSING I•I•:I'.
S 2S.0u
• CHECK 0 - •
FACED PEEMITS WILL ONLY BE ACCEPTED
OFA MAJOR CREDIT
EXPIRES:
;
TOTAL l PERMIT FEF. DU!?
MINIMUM PERMIT FEE IS $35.00
PLEASE MAKE CHECKS PAYABLE 10
SPOKANE COUNTY PERMIT CENTER
NUMBER:
SIGNATURE:
Spokane County Division of Building & Code Enforcement
1026 West Broadway Avenue * Spokane WA 99260
Tel. No. (509) 477-3675 * Fax No. (509) 477-7198 * '11)1) No. (509) 477-7133