1999, 10-20 Permit App: 99010101 Sewer, Plumbing Fixtures Spokane County Division of Utilities
SEWER CONNECTION PERMIT
APPLICATION FORM Q q _ / Ci
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: / ry Line Owner's name: /?,:_otz2,_,,
7 ''ewer? (Y/N)
City: City/State:
Zip: Zip:
Parcel number(if kno„n): 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: .
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Business address: Contact Name:
tom- Cir Cc'< )4
City/State: �`' K f�!
Zip: qqa 1 1 Phone: � -
Phone:
INTERIOR PLUMBING ALTERATIONS?�no) curie one
Fill out the information in the table below if pplicable**
Contractor(if dirent from above): Phone:
Business Address: City/State/Zip:
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....... .................
**For plumbing reversal- ee:litf
ornuhi seetevErssYrteofth#s form
FEE INFORMATION
Sewer Connection: Number of Buildings X(tina)$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 not covered here, call the County Division of Utilities @ 456-3604)
APPLICANT SIGNATURE:
Return to:
Spokane Cosa.y Division of Building&Planning
Vest 1026 Broadway Atensee Spokane, Washington 99260
PHONE: (509) 456-3675 *FAX: (509) 324-3198 TDD: (509) 324-3166
Spokme County don not d:s -_--Eric on no-.as o.tesbh:c <.c r oO ,:_rood or e-c,:oymenc U\ra prcaiTi or xvtOei ......_. _
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER: PHONE:DAYTIME CONTACT
MAILING ADDRESS:
(street) (city/state) (zip)
CONTRACTOR: \D 1,1t\1C('S PL-t).i'AN G LICENSE: y1.:,'� 1J(. r D 33.'�' ✓1/1
PHONE:
MAILING ADDRESS: �a L-\E Sto<+4 N E w A- Gila s
(street) (city/state) (zip)
PLUMBING FIXTURES #OF MULTI- COST
DESCRIPTION DETAIL UNITS PLIED BY /UNIT EQUALS AMOUNT
BQ2;'TOILETS WATER CLOSETS,BIDETS x $6 = $
4.9qii URINALS - x $6 = $
•
iB04 TUBS BATH,JACUZZI,SPA,GARDEN X $6 = $
'3015,SHOWERS(per trap) BASE,STALL,ON-SITE BUILD X $6 = $
BO < SINKS LAVSBASI:S,BAR,FLOOR-KITCHEN, x $6 = $
LAUNDRY,UTILITY,JANITOR,PHOTO,
X-RAY,FOOD(PREP/CULINARY/MEAT)
00a DISHWASHER x $6 = $
B08 CLOTHES WASHER - x $6 = $
13:09::GARBAGE DISPOSAL/GRINDER - x $6 = $
;BSO'WATER SOFTENER- - x $6 = $
B €'ELECTRIC HOT WATER TANKS (NOTE: if gas water tank see mechanical) X - $6 = $
EI 'FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6 = $
313 ROOF DRAINS/OVERFLOW DRAINS - x $6 = $
RUC FOUNTAINS, DRINKING - x $6 = $
a 5 WATER PIPING/DRAIN-WASTE-VEN INSTALLATION,ALII.RATioN,REPAIR X $6 = $
PLUMBING REVERSALS REVERSALS
:111.&SEWAGE EJECTORS GRINDER,SUMP PUMP X $6 = $
WATER USING DEVICES ICE AND/OR COFFEE MAKER, X S6 = $
HOSE BIB,STEAMER,PROOFER,
CARBONATOR,SWAMP COOLERS
CROSS-CONNECTION DEVICES VACUUM BREAKER,CHECK VALVE, x $6 = $
AND R.P.B.P.D.FOR VATS.SUMPS,
TANKS,BOILERS,&SPRINKLER SYSTEMS
:319 INTERCEPTORS GREASE TRAP,SAND TRAP, x $6 = $
CHEMICAL HOLDLNG TANK
132O MEDICAL GAS(per outlet/bottle station) NITROUS,OXYGEN X $6 = $
B2.]:::.MISCELLANEOUS FIXTURES x $6 = $
NOTE: MINIMUM PERMIT FEE IS $35.00 Subtotal
PLUS: PROCESSING FEE $25.00
U RESIDENTIAL ❑ COMMERCIAL TOTAL PERMIT FEE DUE $
SIGNATURE:
PLEASE<1kMA C CKS 'AYABLE 'f
Spokane County Division of Building& Planning : Q fNE COU ."Sf: ERML`P CENTER.::::
1026 W. Broadway Avenue * Spokane, 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.
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