1999, 10-20 Permit App 99010099 Plumbing, SewerSpokane County Division of Utilities
SEWER CONNECTION PERMIT
APPLICATION FORM
t ASE NOTE: This applicatiot(ifornt must be filled out accurately and in its entirety, and signed, or a permit will not be issued.
' 1 :o 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
�te) / d an a Sewer? (Y/N)
City: SPOKAP,F, WA
/ip: q7?f
Parcel number (irknow„ ): vA, •�
v.) GSA
Owner's name: f_
cie f
City/State: SPOKANE , WA
Zip: Orel l o�
Phone: `i (-- 76 33
ir.ct-time contractors or home -owners performing the installation must first contact the utilities department (in person or via phone
156-3604J) before a permit can be Issued
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Contractor (company name):
C.C.I.
State contractor license number:
CENTECI123NE
Business address:
W 21200 HIGHWAY 53/P.O. Box 674
City/State: RATHDRUM, IDAHO
Zip: 83858 Phone: (509) 92.1 —1.994
Contact Name:
DON SWANK.- 130J& 5,uvE1.r
Phone: (509) 921-1994
INTERIOR PLUMBING ALTERATIONS?
Fill out the information in the table below if apph a le**
circle ane
Contractor (if different from above): Phone:
City/State/Zip:
Business Address:
For pfumi mg reversal jee nformafwn, ereverse.sldet,•
FEE INFORMATION
ewer Connection: Number of Buildings ]. X (times) $100 (la bldg) = $ 10 0.0 0
TOTAL FEE
- For a single-family residential unit, one permit is required;
For a condominium, townhouse, duplex, triplex or fourplex with separate ownership (as determined by lot lines) separate
address and separate stub, one permit is required per address per stub;
• For a single building duplex, triplex or fourplex with single ownership, one permit is required
- Multiple buildings (apartments, industrial complexes) with single ownership, one permit required per building connecting to
the sewer.
(For situations not covered here, call the County Division of Utilities ®456--3604)
APPLICANT SIGNAT
Date:
Return to:
SIAgbie C.rn1y Divert ..fBriidng c Pianxenp
Inert 1026 Br'adrvyAmer(Spokane, W'ashinaton 99.760
PHONE (509) 456-3675 i FAX: (509) 324-3198 * TDD: (509) 324-31CY
^Y .n. Cewe, don not dteenten1 ft. en St. Aaea o(dtf.Adtta n e1..dnvnon fn- of trntrn.nt -, .mslorant tn. i0 p[oron. of activism n,�w•r---� —� —
PLUMBING PERMIT APPLICATIONN>}:
POJECT ADDRESS:
WNER:
' ULANG ADDRESS:
''NTRACTOR: C.C.I
�i1..ING ADDRESS: SI 2120 Highway
PI(ONICu DAYTIME CONTACT
(street) (city/state)'
(zip)
LICENSE( CENTECI123NE
5'/P.O. Box 674
street
PHONE: (509) 921-1994
RATHDRUM, IDAHO 83858
(city/state) (zip)
PLUMBING FIXTURES
DESCRIPTION DETAIL
# OF
UNITS
Matti
?LIED RV
COST
/UNIT
Evu*ts
AMOUNT
$ L
EOZ
TOILETS
WATER CLOSETS. BIDETS
1
X
56
=
RO3
URINALS
x
S6
=
$
1104,
TUBS
BATH. JACUZZI. SPA. GARDEN
X
$6
=
$
13.05
SHOWERS (per trap)
BASE, STALL. ON -SITE BUILD
1
x
36
=
$ 4
Hfli5:i
lbLAUNDRY.
�y "byz
SINKS
LAYS/BASINS. BAR. FLOOR. KITCHEN
UTILITY. JANITOR. PHOTO-
X-RAY. FOOD (PREP/CULMARY/M AT)
1
x
$6
=
5 _..
WM
DISHWASHER
x
36
=
$ --
B%8!'
CLOTHES WASHER
-
x
$6
=
$
BO
GARBAGE DISPOSAL/GRINDER
x
$6
=
$
31:(J
WATER SOFTENER
-
x
$6
=
$
Eta
(NOTE itaas water tank sm mr-hint^t)
x
S6
=
5
ELECTRIC HOT WATER TANKS
BIZ
FLOOR DRAINS
AREA. CASE. COIL. TRENCH. CONDENSATE
I
x
56
=
$ 4
R
ROOF DRAINS/OVERFLOW DRAINS
-
x
56
=
5
&XI
FOUNTAINS, DRINKING
-
x
$6
=
$
$151
:s;;'
WATER PIPING/DRAIN-WASTE-VEN
PLUMBING REVERSALS
USTALLATToN.ALTERATJON.REPAJR.
REVERSALS
i
x
$6
=
$ -._
Me
SEWAGE EJECTORS
GRINDER SUMP PUMP
x
S6
=
$
mg.
G`Po
WATER USING DEVICES
am AND/OR COFFEE MAKER.
HOSE HID, STEAMER ?ROOFER.
X
56
_
=
5
CARBONATOR. SWAFP COOL cRC
at 8
db`47::4
CROSS -CONNECTION DEVICES
vACUUMBRcsrfl C}EQ vALvE.
x
$6
=
$
AND RP.B.P.D. FOR VATI SUMPS.
TANKS, BOLERS & SPRINKLER SYSTEMS
BM
INTERCEPTORS
GREASE TRAP, SAM)TRAK,
CHEMICAL HOLDING TAM(
x
$6
-
=
$
B2t
MEDICAL GAS (per outlet/bottle station)
NITROUS. OXYGEN
x
56
=
$
B2`
MISCELLANEOUS FIXTURES
x
56
=
$
Spokane
NOTE: MINIMUM PERMIT
0 RESIDyk F�NTIAL ❑
SIGNATURE
FEE IS $35. 00
COMMERCIAL,
Subtotal
So.'s
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE
5 % oO
ASE»A1 RS PAYAB E Tf3
!q 4:1, .EERMI . a T.I?R
YOMP
County Division of Building &Planning.
t oco rr. . .. .. _..... .._ _.
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.
ICWl4d% sa .n.h 1