1994, 10-25 Permit App: 94010696 SewerSEWER CONNECTION PERMIT
*THIS APPLICATION FORM MUST BE FILLED OUT
SIGNED OR PERMIT WILL NOT BE ISSUED.
JOB ADDRESS: 5• 7.64P /5 1-Ae e
APPLICATION FORM
ACCURATELY AND IN ITS ENTIRETY AND
(IF KNOWN)
PARCEL NUMBER:
ZIP CODE: 9 9 Z e'
ADDRESS:
ZIP CODE:
CITY: 57U/64"71/6-- STATE: YV4Y
OWNER NAME: JP,4T/Z/C-
CITY: Sn6.CAA/ e- STATE: 1it/f;"
PHONE NUMBER: 9 z G 0'743
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS
CONTRACTOR: AIvJo\1b5 Ath\P. ADDRESS: .P.(l. frv_
CITY: SenVilinx> STATE: WA ZIP CODE:
PHONE NUMBER: 151Qt- or -,nn
STATE CONTRACTORS LICENSE NUMBER: A Lvi A' -I A -xE• 106, Q 5
THE UTILITIES
ISSUED.
li.l-L5( L
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTS
INTERIOR ALTERATI BY:
ADDRESS: ,
CITY: 5,0 R47VG�-
STATE: I<4 -ZIP CODE:
TION ? YES NO (C ONE)
PHONE NUMBER:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION 'if OF BUILDINGS X 50.00 =
INTERIOR PLUMBING ALTERATIONS:# OF BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $
APPLICANT
SIGNATURE:
SPOKANE COUNTY. DEPT., OF BUILDINGS
WEST 1026 BROADWAY.AVENUE
SPOKANE,•1.9926d `.
DATE: -• /04r%v