2001, 04-29 Permit App: 01006487 Sewer opn�keittl+ k..tiunty iii.'Vlswit 0i Utilities
SEWER. CONNECTION PERMIT
APPLICATION FORM
_EASE NOTE: This application foil-um=be filled out ace rattly and in its entirety,and signed,or a pe,rnut will not be issue,-
iso nett that sewer permits are valid for 12 months Baan the date of is xuu e, 'No extensions will be granted.
PROJECT INFORMATION
lob address:
g..,-/_)_.4,...1„_,,44,eite.-d ‘,..x-i-e---- -
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Ci `/.Z F, Dry Line Owners name:
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C 4.6,,,', r .. City/ to:„- .,l : ee,�. ,rrU/t
-'p: Zip: -: k/a / • - +a-,- c.)
Parcel number(in w,,.i:
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,r.51-lime contractors orborne-owners
PvrfOrrning ills inatallation Must first contact the utilities department Ott patina or via p!]c:A
'56-3604J)6-3604J)before a permit can be issued
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Name of Utilities Division person contacted: ,r p,f(, ,,_ ^ �y o/
CONTRACTOR INFOTRMATION, v
.,ontractor(company name): State contractor license number:
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usiness address: � � Contact �axe., � _, �d - u S . ( ,l1, .p,at oil Al ,.s _._..y.____.._.
,19- 47 A 4/
.aty/State: ee.5,Aizovi e' -1 {Tt,✓, _ '_
°,ip: y vol‘ Phone: 89-8'• L fI Phone:ea 957 CZ 6r�,, ` It
INTERIOR PLUMBING ALTERATIONS? (y ) .L.A.. Ytt,
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nn. '�"��” ''��'e?3�:��"Sa:�E'7,,,fUf•O Su:�W�a 8t fJ'ery�.
Contractor (if different from above): Phone:
BusinessAddress: City/State/Zip:
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a s J'1�s i �',44a�i��.3'cIM11�1axfy.�+i'I����C"yi9 �i�`�+�0�'� '�.fes�4t� i �`
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FEE INFORMATION _
ewer Connection: Number of Buildings / X ,$)SIN Ow 4 $ /O
TOTAL PEE
.dor a single:family residential unit, one permit is requited;
For a condominium, farmhouse, duplex,triplex or foterplerx with separate ownership(as determined by lot litres)separu
address and separate stub, one permit is required per oar=per stub;
Far a angle building duplex, triplex or fourplkz with single amiership,one permit is requited
Matti*buildings(apartinerrts, industrial complexes)with single ownership, one permit required per building connecting A
the sewer.
(F,ir situations not c*vriered here, call the Caunty Division of Utilities®1456,1604)
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PPL1CANT SI ,:::1.....:-.-R, _:_._ /2-9/0/
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r1/ /,,,,,r " 0,„ito. ? L'9-41- b(14-4e-wuy 1026B~4,Amons"Spokane, Wati,ti{rarrP'2.50
j PHONE:(509)456-3675 ''FAX:(509) 324-•3298 4TDD:(509)324 :P- 5o
I 1m•C...11C..Q.,CuCtm:Ac:c an c,.Laos of dlyS 111.7:•.:11.4 c>C:i,sun W,of Viettrant of 1Q yheirrttai.(UI.Q% fl c W_ utUM.,...+.n.w M.
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