1996, 08-29 Permit App: 96007029 Sewer NNECTION PERMIT o��'-~1C�7_��
SEWERCC�►
APPLICATION FORM 9b 70 3(
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. �� C1
PROJECT INFORMATION � T")
Job address: �` Dry Line Owner's name:
11 baa e. ( 1.1. Sewer? (y9 ' 4W) , 0 , . le6
City: &F.b►ech v, City/State:,Sfokt,„o,/ (A:4 , /
Zip: 14424/Q Zip: 9 q,2o 4
4,
fr
Parcel number(if known): Phone:
5 421 'kb 3 go?7-ae,c,
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:
.S C o,f 1 S i"( L A L-1---i on kis Cf-)&14- 1.2.3.14c
Business address: Utilities installers permit number:
I I ca 1 `-') Y11,11,34\A/00,1
City/State: r,c4Keinc..., I WA-I
Zip: ci G 2 d(„ Phone: CI 2 (p -• Cl (n 4
INTERIOR PLUMBING ALTERATIONS? 4' o) circle one
Fill out the information in the table below if applicable**
Contractor(if different from above): Phone: 9 2,1 - G c. a
- s ab . a . . • bkiAik
Business Address: Cit ate/Zip:
115 2,o t=. ((Ai r e_eAac rr_s WA l q,o i
;'� � 5yN � #00/10;4 grevers� " f P t e e side 41 h fo " ,. 4 a '
FEE INFORMATION
Sewer Connection: Number of Buildings ) X(tunes)$50(per bldg) = $ 56. On
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 County Utilities Division @ 456-3604)
APPLICANT SIGNATURE: U-C 1frILit Date: g/937/4.
.i ( ( ( ( ;
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.
12495 C,wlnwmd‘mw.t.pfk
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER: PHONE:DAYTIME CONTACT
MAILING ADDRESS:
(street) (city/state) (zip)
CONTRACTOR: 0107 c..1._ \)c-,KA 5 - n -P l�.c m L�,<IL LICENSE:,Q p I 42 \ c g 1
PHONE: vv`
MAILING ADDRESS: I el 5 20 L- 1 L.-�(` G�_ (044 e ar i t s A a ll o t tp
(street) (city/state) (zip)
PLUMBING FIXTURES #OF MULTI- COST
DESCRIPTION I DETAIL UNITS PLOW ar /UNIT aOUM.s AMOUNT
1302 TOILETS WATER CLOSETS,BIDETS x $6 = $
B1ti3 URINALS - x $6 = $
;B04 TUBS BATH,JACUZZI,SPA,GARDEN x $6 = $
BO5 SHOWERS(per trap) BASE,STAB,ON-sITEBUILD x $6 = $
306 SINKS LAVs/BASINS BAR,FIOOR,KITCHEN, x $6 = $
LAUNDRY,UTILrrY,JANITOR,PHOTO,
X-RAY,FOOD(PREP/CULINARY/MEAT)
1307 DISHWASHER • - • ' x $6 = $
1308 CLOTHES WASHER - x $6 = $
B09 GARBAGE DISPOSAL/GRINDER - x $6 = •$
131Q WATER SOFTENER - x $6 = $
1311 ELECTRIC HOT WATER TANKS (NOTE: if gas water tank,see mechanical) X $6 = $
.B12 FLOOR DRAINS AREA,CASE,COIL.,TRENCH,CONDEI. ATE x $6 = $
"B13 ROOF DRAINS/OVERFLOW DRAINS(ea.) - x $6 = $
$14 FOUNTAINS,DRINKING - x $6 = $
31:5 WATER PIPING/DRAIN-WASTE-VENT/ 1O ALTERATION,REPAIR, I x $6 = $
PLUMBING REVERSALS REVERSALS
116 SEWAGE EJECTORS GRINDER SUMP PUMP ' x $6 = $
B17 WATER USING DEVICES • . ICE AND/OR COFFEE MAKER, x $6 = $
HOSE BIB,STEAMER PROOFIIR,
CARBONATOR SWAMP COOLERS
B18 CROSS-CONNECTION DEVICES VACUUM BRFAKER,CHECK VALVE, x $6 = _$
AND R.P.B.PD.FOR:VATS,SUMPS,
TANKS,BOILERS,&SPRINKLER SYSTEMS
B19INTERCEPTORS GREASE TRAP,SAND TRAP, x $6 = $
CHEMICAL HOLDING TANK
.$20 MEDICAL GAS(per outlet/bottle station) NITROUS,OXYGEN x $6 = $
B21IMISCELLANEOUS FIXTURES x $6 = $
NOTE: MINIMUM PERMIT FEE IS$35.00 Subtotal /p.00
zy
PLUS: PROCESSING FEE $25.00
SIGNATURE: _ TOTAL PERMIT FEE DUE $ 35-00
PLEASE MAaEt CxACtS i*YoiC:tft.+
Spokane County Division of Buildings SPOKANE COUNTY PERMIT 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.
fa695 Wr.npl.4.,"-ti