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1992, 11-30 Permit App: 92010444 SewerSEWER/PLUMBING PERMIT APPLICATION FORM c95-09I INFORMATION WORKSHEET JOB STREET ADDRESS: S., 122_o �A�� 1D_ I -N CITY /STATE /ZIP: spy' / )w 992I4' PARCEL NUMBER: —) \ 611 \ OWNER: ���Y /r i.)r ,,ns PHONE NUMBER: MAILING ADDRESS: '` (Street) (City /state) (Zip) CONTRACTOR: Plii3C '' 4- - A- i LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: ' 94f 5- :�in)u 44 �Jf�Lt- e- -y/cO'v , 6U✓4 999). <- (City /state) (Zip) (Street) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT = AMOUNT X 50.00 = X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE _$ SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456 -3675