1992, 08-04 Permit App: 92006028 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS: S. gO lv v .
CITY/STATE/ZIP:,,__,,l LP ItB.///n �/ PARCEL NUMBER:
OWNEROZ /JO PHONE NUMBER: 9-29-
MAILING ADDRESS:
u3o
c12- 62 01_,Y
CIE S-17)
2093,
(Street) (City/state) (Zip)
CONTRACTOR: N F g CONS TKUCTION LICENSE NUMBER: HS CON *4 IZ3KF
PHONE NUMBER: 926 891c4
MAILING ADDRESS: C. tel UALLegwA`I AVE SPCk.ANE WA gRQO6
(Street) (City/state)
(Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
X EACH
UNIT
=AMOUNT
X 50.00 =
X 35.00 =
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
_$
50
4.5aaq,o,of
SomMtr w000uoA D �k
L ) -�
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675