Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
2000, 03-20 Permit App: 00001762 Sewer
♦j1 ,i .ne County Division of Utilities it I, R CONNECTION PERMIT , I (. ( 0 APPLICATION FORM .! ,fin/ � oq 2� PLEASE N.' 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: L /017 E. / A Sewer? (\€ 7T d Mt--/-1) 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: -TLC Cotes 7 ta tit ci i o -1-.Cco -IG>-7 (p Business address: Contact Name: `"t Do(o S. H 1 D 12O City/State: O - NES (A) Zip: \ O 4 Phone: Phone: Q (i7(o 0 INTERIOR PLUMBING ALTERATIONS? (yes no) ' e one Fitt.out thein ormation in the table below• licable** Ctractor(if different om above): Phone: q a a- 1544 STu)A - t VLL&(Vl i N t� Business Address: City/State/Zip: • tsq tto c, ALK' G IvAZ E3 WA-96101 (0 xvr purhingrgs+ rsrEl+ `:iii . FEE INFORMATION Sewer Connection: Number of Buildings ( X(times)$100(per bldg) =$ (00,©C) TOTAL FEE • For a single-family residential unit, one permit is require • 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: ' t'"{t� ��.u/l/' c n't� Date: ,,,,ll Return to: Spokane County Division of Building&Planning West 1026 Broadway Avenue*Spokane, Washington 99260 PHONE:(509)456-3675 *FAX:(509)324-3198*TDD:(509)324-3166 Spokane County does not disaurunare on du basis of dsabtttty to the adnnsnon to,or treatment or employment in,its progarns or activities tsnvw.\-..-.M...ent PLUMBING PERMIT APPLICATION PROJECT ADDRESS: OWNER: PHONE:DAYTIME CONTACT MAILING ADDRESS: (street) (city/state) (zip) CONTRACTOR: Lk) i\---\ j ALL fl 1 IBJ�.• LICENSE: f "Ttc.)P*08 B YW T 1 nn PHONE: MAILING ADDRESS: 1, Bq Co -CAu L I /�V(2CE(UAC ) OA- c1c10c 6 (street) (city/state) (zip) PLUMBING FIXTURES #OF MULti- COST DESCRIPTION DETAIL UNITS PLIED BY /UNIT EQUALS AMOUNT . 4Z'TOILETS WATER CLOSETS,BIDETS X $6 = $ MI!:URINALS - x $6 = $ 10 TUBS BATH,JACUZZI,SPA,GARDEN X $6 = $ E5' SHOWERS(per trap) BASE,STALL,ON-SITE BUILD X $6 = $ 0i:: SINKS LAVSBASINS,BAR,FLOOR,KITCHEN, X $6 = $ "`"''' LAUNDRY,UTILITY,JANITOR,PHOTO, X-RAY,FOOD(PREP/CULINARY/MEAT) Wi DISHWASHER - x $6 = $ wfx CLOTHES WASHER - x $6 = $ B0 GARBAGE DISPOSAL/GRINDER x $6 = _$ - 13 WATER SOFTENER - x $6 = $ OW:ELECTRIC HOT WATER TANKS (NOTE: if gas water tank,see mechanical) X $6 = $ FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE x $6 = $ Ai ROOF DRAINS/OVERFLOW DRAINS x $6 = $ It' 'FOUNTAINS,DRINKING - x $6 = $ gelli WATER PIPING/DRAIN-WASTE-VEN INSTALLATION,ALTERATION,REPAIR, X $6 = $ fig PLUMBING REVERSALS • REVERSALS 131:x;:SEWAGE EJECTORS GRINDER,SUMP PUMP x $6 = $ ' ".WATER USING DEVICES ICE AND/OR CON.E.b.MAKER, x $6 = $ HOSE BIB,STEAMER,PROOFER, .<`•'E* CARBONATOR,SWAMP COOLERS $ CROSS-CONNECTION DEVICES VACUUM BREAKER,CHECK VALVE, x $6 = $ AND ILP.B.P.D.FOR:VATS,SUMPS, is ? TANKS,BOILERS,&SPRINKLERSYSTEMS ,.g ficts INTERCEPTORS GREASE TRAP,SAND TRAP, x $6 = $ MEN CHEMICAL HOLDING TANK 1 ' MEDICAL GAS(per outlet/bottle station)NITRoUs,OXYGEN x $6 = $ ..1-SMA `I ) :MISCELLANEOUS FIXTURES x $6 = $ NOTE: MINIMUM PERMIT FEE IS$35.00 Subtotal PLUS: PROCESSING FEE $25.00 ❑ RESIDENTIAL ❑ COMMERCIAL TOTAL PERMIT FEE DUE $ SIGNATURE: iiIIIVIANEMiltneXIMIONSMONON agnoili Spokaneok ane CountyDivision on of Building & P I nin . � y �� :C .1 �NS 1026W. BroadwayAvenueS Spokane,WA 99260 ... Tel.No. 0 - 5 9 4563 7 - 6 5 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. 10/14/96\ma ster\pkumpenn.hfld