Loading...
1995, 03-28 Permit App: 95001812 Sewer SEWER CONNECTION 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. PROJECT INFORMATION Job address: Owner's name: City: City/State: Zip: Zip: Parcel number (if known): Phone: WILL THE PROPERTY OWNER BE PERFORMING THE SEWER CONNECTION INSTALLATION?* Yes No *If property owner is installing the sewer connection, they must first contact the UTILITIES DEPARTMENT for construction requirements before the permit is issued. CONTRACTOR INFORMATION Contractor (company name): State contractor license number: 14 4 S Co(lc c+,'on N S an 123.k.F Business address: Utilities installers permit number: City/State: AS 4 k r\F k A Zip: q g 2 D �c Phone: G - S G c„14 INTERIOR PLUMBING ALTERATIONS (if applicable)** Contractor (if different from above): Phone: Business Address: City/State/Zip: ** For plumbing reversal fee information, see reverse side of this form. FEE INFORMATION Sewer Connection: Number of Buildings X (times) $50 (per bldg) _ $ TOTAL FEE (One permit required for each separate building, shop,garage, etc., that will be connected to the sewer) APPLICANT SIGNATURE: Date: Spokane County Division of Buildings West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675