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1996, 09-05 Permit App: 96007413 Sewer /- SEWER CONNECTTION PERMIT q/, '47 11 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: Z I ? scra_ Sewer? (Yo City: I gf f City/State: stree.. ,. e- A. tOri, Zip: G ZLga 1 ```. ,/v p: Z-0 tri' 4 Parcel number(ifknown): Q one: 4105 -D`t t S 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: 'lo.E K CONTRACTOR INFORMATION Contractor (company name): State contractor license number: i r E>< GaVGL-hnJ ALLl _i lit L Z. Business address: ✓ Utilities installers permit number: �5. q 3rr e.e can ,Dr. City/State: M ect cal L tAJ1A Zip: q q o2-2. Phone: 2 q q - I I INTERIOR PLUMBING ALTERATIONS? ( o) circle one Fill out the information in the table below if applica e*** Contractor (if different from above): Phone: C 2 8 - 313 r7 c art,. crn PS Business Address: City/State/Zip: . Z C- I . c-5* atm s_ -C.-- cl 1(0 **For plumbing reversal fee information,see reverse side of this form. FEE INFORMATION cc� Sewer Connection: Number of Buildings t X(times) $SO(per bldg) = $ Jk), `'`:1 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: Date: (/ =t 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. 1/25/95c\,.,o. . .'pi PLUMBING PERMIT APPLICATION PROJECT ADDRESS: i 2 f z...-1 C 9 is OWNER: 5"),1/4/4.4 Sc.--.4.--4._ PHONE:DAYTIME CONTACT L}- _ov 73 MAILING ADDRESS: 1 Zi lit L- "C , ,,,c,•Qeze,�� ` L. _ 91-7.:>G• `/ (street) (city/state) (yip) CONTRACTOR: CQr _rip em Pis LICENSE: e M re,-* 0/01 LO PHONE: 92.8 •,..313r7 MAILING ADDRESS: I (4.7.5 o cps E, Lc o ci{em ow alne WA- 9c/2/L. (street) city/state) (zip) PLUMBING FIXTURES #OF mum- COST DESCRIPTION I DETAIL UNITS MED BY /UNIT mQunt.s AMOUNT B02 TOILETS WATER CLOSETS.BIDETS X $6 = $ B03 URINALS - x $6 = $ B04 TUBS BATH,JACUZZI,SPA,GARDEN x $6 = $ 1305 SHOWERS(per trap) BASE,STALL,ON—SITE BUI D 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 DISPOSAUGRINDER - x $6 = $ 810 WATER SOFTENER - x $6 = $ B11 ELECTRIC HOT WATER TANKS (NOTE if gas water tank see mechanical) x $6 = $ 1312 FLOOR DRAINS AREA,CASE,COIL.TRENCH,CONDENSATE X $6 = $ B13 ROOF DRAINS/OVERFLOW DRAINS(ea.) - x $6 = $ B14 FOUNTAINS,DRINKING - x $6 = $ 1315 WATER PIPING/DR IN-WASTE-VENT/ INSTALtATIOK ALTERATION,REPAIR, x $6 = $ PLUMBINLEVERSAM2, REVERSALS 6 ..0 BI6 SEWAGE EJECTORS GRINDER SUMP PUMP x $6 = $ 1317 WATER USING DEVICES ICE AND/OR COFFEE MAKER, X $6 = $ HOSE BIB,STEAMER,PROOFER, CARBONATOR.SWAMP COOLERS B18 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 1320 MEDICAL GAS(per outlet/bottle station) NITROUS,OXYGEN X $6 = $ B21 MISCELLANEOUS FIXTURES x $6 = $ NOTE: MINIMUM PERMIT FEE IS$35.00 Subtotal 6 a'0 PLUS: PROCESSING FEE $25.00 SIGNATURE: & , Ah-s.,c TOTAL PERMIT FEE DUE $ 3 W 90.4,,,c,O, PLEASE MAKE CHECKS PAYABLE TO 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. TRANS ai*Apk.O„a►d