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1996, 08-29 Permit App: 96007033 Sewer . , , q (),..--io 3:5 • SEWER CONNECTION PERMIT APPLICATION FORM )t,2 �- C 3 4 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 q05-?0 (0 Job address: Dry Line Owner's name: 0 JJ6a a o . - Sewer? (Y© ) , 2/1.0 . • City: S o _ City/State: S' Wu., . ? Zip: q zip: 99ao6 .. Parceltuber(ificnown): Phone: 90?,7 d.269:6�-� i j BOO 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 CCSCI S r(t A (A-I'ne) H S C.(-)l\l- 4t _1..2 3 KF Business address: Utilities installers permit number: 11 c3V1 r1 L 0 f,I 1 e al y,/cw City/State: r,c-avinc, I vJA- Zip: q c4 2 d(r) Phone: co.(p -•e ci _,Li INTERIOR PLUMBING ALTERATIONS? no) eirdeone Fill out the information in the table below if applicab e** Contractor(if different from above): Phone: 9 2, 1 - q O 8 8 + J cal - cz( 2L.A \ Business Address: Cit ate/Zip: x '15 2,v i . ('4h CI r e_erlac_rr.s WA clqc i t ' §�Ew .�� ..-04Plumhlt�g reversal e lt)jPtM4t M-geMfr �rtge n.RyPrm �w' ••'61 , FEE INFORMATION Sewer Connection: Number of Buildings I X(times)$50(per bldg) = $ ,5 0-oD 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: ' &Y/n't".2 Date: 8/029/9A 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. »cWismwAsswer.Pik PLUMBING PERMIT APPLICATION PROJECT ADDRESS: OWNER: PHONE:DAYTIME CONTACT MAILING ADDRESS: (street) (city/state) (zip) CONTRACTOR: D r 4- \)tom l.A 5to n -P l urR Li rR LICENSE:,k O g ,0.. ,{ 5 B 1 �J PHONE: ,, / Tn MAILING ADDRESS: r] S2.0 C . (0.1' 1 61(`Ct�Acl'tS YY A c► Q DI kJ (street) (city/state) (zip) PLUMBING FIXTURES #OF Dann- COST DESCRIPTION I DETAIL UNITS ru oar /UNIT UQUALS AMOUNT B02 TOILETS WATER CLOSETS BIDETS x $6 = $ BO URINALS — x $6 = $ B04 TUBS BATH,JACUZZI,SPA,GARDEN x $6 = $ BUS SHOWERS(per trap) BASE,STALL,ON—SITE BUILD x $6 = $ 1306 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN, x $6 = $ LAUNDRY,UTILITY,JANITOR,PHOTO, X—RAY,FOOD(PREP/CULINARY/MEAT) 1307 DISHWASHER - ' x $6 = $ 1308 CLOTHES WASHER — x $6 = $ B09 GARBAGE DISPOSAL/GRINDER — . x $6 = •$ 1310 WATER SOFTENER — x $6 = $ Eli ELECTRIC HOT WATER TANKS (NOTE: if gas water tank,see mechanical) X $6 = $ 1312 FLOOR DRAINS AREA,CASE,COB,TRENCH,CONDENSATE x $6 = $ an ROOF DRAINS/OVERFLOW DRAINS(ea.) — x $6 = $ B14 FOUNTAINS,DRINKING — x $6 = $ 1315 WATER PIPING/DRAIN—WASTE—VENT/ INSTALLATION ALTERATION,REPAIR. I x $6 = $ t PLUMBING REVERSALS REVERSALS B16 SEWAGE EJECTORS GRINDER.SUMP PUMP - x $6 = $ B17 WATER USING DEVICES • ICE AND/OR COFFEE MAKER, x S6 = $ HOSE BIB,STEAMER PROOFEPR, CARBONAIOR SWAMP COOLERS 01:S CROSS—CONNECTION DEVICES VACUUM BREAKER,CHECK VALVE, X $6 = $ AND R.P.B.PD.FOR:VATS SUMPS, TANKS,BOILERS,&SPRINKLER SYSTEMS B19 INTERCEPTORS GREASE TRAP,SAND TRAP, x $6 = $ CHEMICAL HOLDING TANK B20 MEDICAL GAS(per outlet/bottle station) NITROUS,OXYGEN x $6 = $ B21 MISCELLANEOUS FIXTURES x $6 = $ NOTE: A�IL.NIMUMPERMIT FEE IS$35.00 Subtotal >a op PLUS: PROCESSING FEE $25.00 SIGNATURE: ()) L. (j( TOTAL PERMIT FEE DUE $ 3.5..00 PLBA,St MAKE NECIWP..i NAB Tlb Spokane County Division of Buildings :,:SPOKANE GOUNTYPERMITCENTER 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.