1999, 08-23 Permit App 99009839 SewerSpokane C,un Division of Utilities �
SEWER CONNECTION PERMIT ^t y
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:
T 96 0 P&c .
Dry Line
Sewer?jY/N)
city: p 1; 4 x-'f
Parcel number (irknown): 99,72 ( 3
First-time contractors or home -owners performing the installation must first contact the utilities department (in person or via phone
j456-3604J) before a permit can be issued.
Name of Utilities Division person contacted:
CONTRACTOR INFORMATION
Owner's name: to , J
, ®l<e4 AYE
City/State:
Zip:
Phone:
Contractor (company name):
GENTERL 11ZE Ca>JS i ocf ON
Business address:
f • i34< 67`k
City/State: R rfl- P Q L)M t D
Zip: ? 3 5$ Phone: cll. 1 1 9'
State contractor license number:
GEjrEar 123 &E
Contact Name:
Cci3 .Si-tivELr
Phone: ci21- 19q'-f
INTERIOR PLUMBING ALTERATIONS? no) circle one
F711 out the information in the table below if applicable
Contractor (if different from above):
Business Address:
Phone:
City/State/Zip:
FEE INFORMATION
Sewer Connection: Number of Buildings f X (ties) $100 (per bldg.) = $ 1 L'�-
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, cal! the County Division of Utilities @ 456-3604)
APPLICANT SIGNATURE:
(-
Date; �Z,�
Return to:
Spokane County Division of Buddhas o' Planning
West 1026 Broadway Avenge 4 Spokane, Warhinakn 99260
PHONE: (509) 456-3675 * FAX: (509) 324-3198 { TDD: (509) 324-3166
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER.:
MAILING ADDRESS:
CONTRACTOR:
P1IONE: DAYTIME CONTACT
MAILING ADDRESS:
(street) (city/state)
street
LICENSE:
PHONE:
(city/state)
(zip)
# OF
UNErs
murat-
,LiED sr
COST
/UNIT
mums
AMOUNT
PLUMBING FIXTURES
DESCRIPTION DETAIL
i
TOILETS
wATER cLosEis, BIDETS
X
x
S6
$6
= $
=
U
URINALS
Mk
TUBS
BATH, JACUZZI, SPA, GARDF.24
.,
X
$6
$6
= $
= $
S
SHOWERS (per trap)
BASE, STALL. 0N-SITE BUIL);
.SINKS
o.,‘,..
,.
LAVS1BASR3S, B AR, FLOOR, KITCHEN,
LAUNDRY, I3111.1TY, JANITOR, MOTO.
X-RAY, FOOD (PREPICULINARY/WAT)
x
$6
•
t:, $
, .
7-
DISH WASHER
.$
x
x
$6
$6
--,-
=
,
.
CLOTHES WASHER
-1
lito.
GARBAGE DISPOSAUGRINDER
.
x
x
S6
$6
=
= $
..
WATER SOI- LINER
•
,A140
flei
ELECTRIC HOT WATER TANKS
(N OTE: if gas water tank,see mechanical)
x
$6
=
PIZ
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6
=
' 'ili..
ROOF DRAINS/OVERFLOW DRAINS
-
x
S6
=
111.14k'
FOUNTAINS, DRINKING
-
x
S6
=
WATER PIPING/DRAIN-WASTE-VEN
PLUMBING REVERSALS
INSTALLATION, ALTERATION. REPAIR.
REVERSALS
X
$6
= $
. ,.
SEWAGE EJECTORS
GRINDER. SUMP PUMP
:
$6
---= $
.
WATER USING DEVICES
ICE AND/OR COFFEE MAKER,
tIOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLERS
X
$6
1
$
=
$
CROSS -CONNECTION DEVICES
VACUUM BREAKER. CHECK VALVE,
AND ILF.B.P.D. FOR: VATS, SUMPS,
TANKS, BOILER.S, & SPRINKLER. SYSTEMS
X
$6
' t I.,,,.,.af
- MS
. ,...1
INTERCEPTOEtS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
1X
$6
=
f.. i
.. ..., .
MEDICAL GAS (per outlet/bottle station)
NITROUS. OXYGEN
x$6
= $
v,...41.1$
flgu MISCELLANEOUS FIXTURES
x$6
=
NOTE: MINIMUM PERMIT FEE IS $.3 .
Ea( RESIDENTIAL 0 COMMERCIAL
SIGNATURE:
Spokane County Division of Building & Planning
1026 W. Broadway Avenue "' Spokane, WA 99260
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 thc admission to, or treatment or employment in, its programs or activities.
Subtotal
PLUS: PROCESSING FEE
$25.00
TOTAL PERMIT FEE DUE $ tf3 42'9