1996, 09-03 Permit App: 96007284 SewerSEWER CON ION PERMIT
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 addres : IDry Line Owner's name:
Sewers (Y
Parcel number(aww..a):
Phone:
First-time contractors or home -owners performing the it
or via phone [456-3604]) before a permit can be issued.
Name of Utilities Division person cor
Contractor (company name):
g,. 2- � Vg iP�
must first contact the utilities department (in person
CONTRACTORINFORMA'
State contractor license number:
Business address: J Utilities installers permit number:
POS I�}2fi2
City/State: NI
Zip: Phone: QZf,' • o�Gci
INTERIOR PLUMBING ALTERATIONS?
Fill at the information in the table below iloaali,
Contractor (if different from above):
Business Address:
IrISSn 9 (144,
City/State/Zip:
FEE INFORMATION
Lr
Sewer Connection: Number of Buildings X(mae) S50 (p. wdg) =$ JL/
TOTALFEE
• One permit requiredfor each separate building, shop, garage, era, that will be connected to the sewer.
• Condos, townhouses, & 2- 3- and 4-ple=s require I permit per address/stub. -
• Multiple buildings (apartments, Industrial complexes) require I permit per building.
(For situations no eyed here,call the County Utilities Dhition@ 456,36"
APPLICANT SIGNATURE: / - Date:
Spokane County Division of Buildings
West 1026 Broadway Avenue' Spokane, Washington 99260
PHONE: (509) 456-3675 e FAX: (509) 324-3198' TDD: (509) 324-3166
Spokane County does not disaiminate an the bests of dleabWty In the admissim to, a treaaneat or amplaymeat In, Its programa or advides.
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER: PHONE: DAYTIME CON Aw
MAILING ADDRESS:
(street)
CONTRACTOR:
MAILING ADDRESS: lS,7r, (% fo41 CI!`O[(NdlflC MIA C1A f>1I—
(street) (city/state) (zip)
c
TOILM
wATeR t]OSCtS Anvers
x
$6
E
URINALS
x
$6
-
S
4
BD4TUBS
BiNirACOIIJ,SPAaAR
x
$6
-
S
SHOWERS extra
v. cv SPAD.ON-SIMR1RID
x
$6
-
S
-::s SINKS
IAVS9LltP1S BARP1DORxn'O@li,
IAUNDRY. [RRDY.IANfI'OR PFIO'10.
X-AAY,POOD PCfAJNMYIAWA
x
S6
=
S
,.DISHWASHER -
x
'$6
=
E
CLOTHES WASHER
x
$6
=
S
O-GARBAGEDISPOSAI/GR INDER
x
$6
=
S
WATERSOFTENER
x
S6
=
S
EIEC'i'RIC HOT WATERTANKS
orexpr.smru.tw.me
x
S6
=
S
FLOOR DRAINS
Aone CASElx1A. TRPNt]1.NNDENSAre
x
S6
=
S
ROOF DRAINS/OVERFLOW DRAINS ea
z
$6
=
S
FOUNTAINS, DRINKING
x
S6
=
$
WATER PIPING/DRAIN-WASTE-VENT/
PLUMBING REVERSALSSEWAGE
DISTAUATIONau TIONRRPA
x
$6
=
E
EJECTORS
ORIImEKSasvm
z
$6
=
S
WATER USING DEVICES
IMISCELLANEOUS:
ItPAND,ORCOPPPLMAXC0.
x
E6
=
E
CROSS -CONNECTION DEVICES
vACTM.tRREM3RlC1RQ' VALVR
ANDRP.RPAF0R:VATSSU.�ST BD GSPRINXIDRSYSIEMSINTERCEPTORS
x
S6
=S
cREA93rRAP.sArroTRAe,
x
$6
=
$
MEDICAL GAS erooabbOAle ststioo
igtao oO aw
x
S6
=
S
T7(TURES
x
S6
=
$
NOTE. M NLUUMPERMIT FEE IS $35.00
SIGNATURE:
Spokane Coolly Division of Building,
1026 W. Bro uhrav Aveave a Soutane. WA 99260
Subtotal
PLUS: PROCESSING PEE
$25.00
TOTAL PERMIT FEE DUE
S
PwmEaMATCE"�HEC'�X"YxY�Y.B
rr
SPOKANE C6iJN1'YPJ�R)tiITC ���tt�nli
,
Tet. No. (509)156-3675 a Fax No. (509) 321-3198 a TDD No. (509) 321-3166
Spinae Couutydocs not d6triminrm on tlm b is otd'uaNity in (W rdmerioo W or treatment erem96yment u. in Mgmos or rttunva.
vsnr�yti.�u