1996, 09-13 Permit App: 96007686 Sewer SEWER CONNECTION PERMIT
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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: ml1,�ZG a € '
%'t irl 0 15Sewer? (Y0
City: S kra P_. City/State: •. tet,. .
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Zip: 47.1/01 O fp ��c..bt,.+ Zi'Lf-- Zip: q 9,R16,
Parcel numbe (if known): t Phone:
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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: ,
4-I .5 COOSi r ot -1-t on H SC.-01J- --v 1.234K,C
Business address: Utilities installers permit number:
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City/State: rS Uf1c_, 4
Zip: c{c-1 2_, Phone: 2 Lc, -•e q (- L
INTERIOR PLUMBING ALTERATIONS? (yes circle one
Fill out the information in the table below if applicable**
Contractor (if different from above): Phone: 9 21 - G c 8 6
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Business Address: Cit ate/Zip:
1 r15 20 t--7. ( 4i re_Cflacrr 5 WA Cl q.o I
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;' kal n* alf plumblr3„g retersaX eitit t511014see etl stns i„ 1hisform 0 .� 40
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FEE INFORMATION
Sewer Connection: Number of Buildings I X(times) $50(per bldg) = $ 5 6•60
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: 0-04414,,e. �)lAnt Date: q/ /i 96
Spokane County Division Buildings
Wes 102 '
6 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.
V26/35 c\ ,il
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS: y
OWNER: PHONE:DAYTIME CONTACT
MAILING ADDRESS:
(street) (city/state) (zip)
CONTRACTOR: 1 P •• r • • LICENSE: . • t, 0_ ttt, _
PHONE: 1i/ n
MAILING ADDRESS: r] S 2 _ (0441 lS Y A- ` i CiD( (
(street) (city/state) (zip)
PLUMBING FIXTURES #OF mum- COST
DESCRIPTION I DETAIL UNITS et.MMBY /UNIT ■ouAts AMOUNT
B02 TOILETS WATER CLOSETS,BIDETS X $6 = $
B03 URINALS — x $6 = $
B0.4 TUBS BATH,JACUZZI,SPA,GARDEN x $6 = $
. SHOWERS(per trap) BASE,STALL,ON—SITEBUILD x $6 = $
1306 SINKS LAVs/BASINS BAR,FIOOR,IUTCHEN, x $6 = $
LAUNDRY,UTILITY,JANITOR,PHOTO,
X—RAY,FOOD(PREP/CULINARY/MEAT) •
B07 DISHWASHER — • x $6 = $
B08 CLOTHES WASHER — x $6 = $
B09 GARBAGE DISPOSAL/GRINDER — x $6 = $
B10 WATER SOFTENER — x $6 = $
1311 ELECTRIC HOT WATER TANKS (NOTE: if gas water tank,ice mechanical) x $6 = $.
'BI2\FLOOR DRAINS AREA,CASE,COIL,TRENCH.CONDENSATE x $6 = $
1313 ROOF DRAINS/OVERFLOW DRAINS(ea.) — x $6 = $
B14 FOUNTAINS,DRINKING — x $6 = $
81;5 WATER PIPING/DRAIN—WASTE—VENT/ INSTALLATION,ALTERATION,REPAIR, x $6 = $
'<•PLUMBING REVERSALS REVERSALS
.816 SEWAGE EJECTORS GRINDER.SUMP PUMP ' x $6 = $
BI7 WATER USING DEVICES • . ICE AND/OR COFFEE MAKER, x $6 $
HOSE BIB,STEAMER PROOFER,
CARBONAIDR,SWAMP COOLERS
1B18 CROSS—CONNECTION DEVICES VACUUM BREAKERCHECK VALVE, x $6 = ,$
NM AND R.P.B.PD.FOR:VATS,SUMPS.
TANKS,BOILERS,&SPRINKLER SYSTEMS
00 INTERCEPTORS • GREASE TRAP,SAND TRAP, x $6 = $
CHEMICAL HOLDING TANK •
:B24f MEDICAL GAS(per outlet/bottle station) NITROUS.OXYGEN x $6 = $
B21 MISCELLANEOUS FIXTURES x $6 = $
NOTE: MINIMUM PERMIT FEE IS$35.00 Subtotal
PLUS: PROCESSING FEE $25.00
SIGNATURE: TOTAL PERMIT FEE DUE $
'`x.04
` . .
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 8 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.
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