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1993, 04-20 Permit App: 93002661 Sewer
s SEWER/PLUMBING PERMIT APPLICATION FORM N3. xr,s2x, INFORMATION WORKSHEET JOB STREET ADDRESS: �7 G ASC f•€��' �� CITY/STATE/ZIP:/.2,6 - Le—,V • PARCEL NUMBER: `� �'' OWNER: t, G� �/ ,"�� _ J PHONE NUMBER: 9 C�a 6 d 8 0\47 MAILING ADDRESS: - ---...---)‹...._k", (Street) (City/state) (Zip) '--- CONTRACTOR: COUA1HAtNE EXC.AYAflo/1 LICENSE NUMBER: CoL_ UCC 184. e? PHONE NUMBER: CW4-54-165 MAILING ADDRESS: 6. 1(01-102. VALLeyiAm AveVe120,,c7aLe Wo, 99037 (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT =AMOUNT X 50.00 = o 'z----' X35.00= �3 c.. - SUBTOTAL $ ^ EQUALS: TOTAL PEMIT FEE DUE _$j. °' SIGNATURE Lci' Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 'rekV\d