1996, 09-06 Permit App: 96007663 Sewer CI - 7(0 o
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SEWER CONNECTION PERMIT
61b3 + 1214-
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' name:
7ADDS' E. /2 Sewer? (Y/N)
City: 44-44,A.,.e., ii.. /r City/State:
Zip: 2�( Zip:
Parcel number(ifknown): Phone: 9,A 6 _z7134/
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:
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Business addrdss: Utilities installers permit number:
-Pc) Pox i R 15(02
City/State: 3 ,. 4n,F__ vs/A
Zip: q q21 Phone: c 2,2- FS, Soo
INTERIOR PLUMBING ALTERATIONS? (yes/no) circle one
Fill out the information in the table below if applicable**
Contractor (if different from above): Phone:
Business Address: City/State/Zip:
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FEE INFORMATION
Sewer Connection: Number of Buildings / X(times) $SO(per bldg) =
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 I 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: 9- ' - 7(a
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.
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PLUMBING FERMIT .k1PPLICATION
I'ROJECI'ADDRESS:
OWNER: PHONE:DAYTIME CONTACT
MAILING ADDRESS:
(street) (city/state) (zip)
CONTRACTOR: LICENSE:
PHONE:
MAILING ADDRESS:
(street) ;city/state) (zip)
PLUMBING FIXTURES • • wtn_ •
DESCRIPTION DETAIL UNITS mato ar AMOUNT
B02 TOILETS 'WATER=SETS,t uuErs A $6 = S
BO3 URINALS — T x $6 = S
1304 TUBS BATH,JACUZZI,SPA.GARDEN x $6 = S
IBOS SHOWERS(per trap) BASE,STALL,ON-SrrEBUILD x $6 = S
1306 SINKS L kVS/BASINS BAR,FLOOR,KITCHEN, x $6 = S
LAUNDRY.UTILITY,JANITOR,PHOTO,
X—RAY,FOOD(PREP/CULINARY/MEAT)
B07 DISHWASHER — _ x $6 = $ _
1308 CLOTHES WASHER — x $6 = $
BO9 GARBAGE DISPOSAUGRINDER — x $6 = S
B10 WATER SOI-I LNER — x $6 = S
,B11 ELEC.I RIC HOT WATER TANKS (NOTE: if gm water tank,see mechanical) X $6 = S
FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE x $6 = $
IB13 ROOF DRAINS/OVERFLOW DRAINS(ea.) — X $6 = $
1B14 FOUNTAINS,DRINKING — x $6 = S
BL5 WATER PIPING/DRAIN—WASTE—VENT/ INSTALLATION,ALTERATION,REPAIR. X $6 = $
PLUMBING REVERSALS REVERSALS
B16 SEWAGE EJECTORS GRINDER SUMP PUMP x $6 = $
B17 WATER USING DEVICES ICE AND/OR COFFEE MAKER. x $6 = $
HOSE BIH,STEAMER.PROOt's ,
CARBONATOR,SWAMP COOLERS
B18 CROSS—CONNECTION DEVICES VACUUM BREAKER,CHECKVALVE, X $6 = S
AND R.P.AP.D.FOR:VATS,SUMPS,
TANKS.BOILERS,&SPRINKLER SYST::MS
f B19 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6 = S
CHEMICAL HOLDING TANK
B20 MEDICAL GAS(per outlet/bottle station) NITROUS,OXYGEN X $6 = S
321 MISCELLANEOUS FIXTURES x $6 = S
NO 1E: MINIMUM PERMIT PEE IS$35.00 Subtotal
PLUS: PROCESSING FEE $25.00
SIGNATURE: TOTAL PERMIT FEE DUE $
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?LEASE MA10E CHECKS PAYABLE TO
Spokane County Division of Buildings SPOKANE COUNTY PERMIT CENTER
1026 W. Broadway Avenue • Spokane, WA 99260
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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.