1996, 09-05 Permit App: 96007418 Sewer 4.1 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: Dry Line Owner's name:
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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:
Businessddress: 1 Utilities installers permit number:
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City/State: (7 11X
Zip: Phone: , % ( 1! (DO
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INTERIOR PLUMBING ALTERATIONS? (yes no))ircle one
Fill out the information in the table below if applicable**
Contractor(if different from above): Phone:
Business Address: City/State/Zip:
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FEE INFORMATION (P-7)
Sewer Connection: Number of Buildings / X(times) $50(per bldg) = $ V
TOTAL FEE
*One permit required for each separate building,shop,garage, etc.,that will be connected to the sewer.
*Condos,townhouses, &2-3-and 4-plexes require 1 permit per address/stub.
*Multiple buildings(apartments, industrial complexes)require 1 permit per building.
(For situations not covered here, call the Co my Utilities Division @ 456-3604)
APPLICANT SIGNATURE:%, Date:esalesesi
9
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260
PHONE: (509) 456-3675 * FAX: (509) 324-3198 * TDD: (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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