1993, 08-16 Permit App: 93007046 SewerL -K 211 . !S U LF
Ter 1g\-41
SEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY
AND SIGNED OR PERMIT WILL NOT BE ISSUED.
( IF KNOWN)
JOB ADDRESS: 5-; j‘, /, p -C{ PARCEL NUMBER:
CITY • S���i ,�%/Y�
STATE: GrrJ�
OWNER NAME: `\°\rU l‘C / /1/./QN/ ADDRESS:
CITY:
ZIP CODE: q(12 -1C%
STATE: PHONE: `� � _ jD 2 2
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: AR.mS-'+2DN& C!ON5TaKTION ADDRESS: ?O. ? OY. 1L 2e 2,
CITY: SPOKANE. I/l1 54.4T -Er: 9g3,' -i PHONE: Q28'0559
STATE CONTRACTORS LICENSE NUMBER..: AQMSTC7+"°1gN1
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES < NO (CIRCLE ONE)
INTERIOR ALTERATION WORK BY..:
ADDRESS: PHONE:
CITY: STATE: ZIP CODE:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC
THAT WILL BE CONNECTED TO THE SEWER.
SEWER CONNECTION • # OF BUILDINGS J X 50.00 = sS -C9,,
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $ C.—e
APPLICAN
SIGNATUR
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 (509)456-3675
08/16/93 08:17 BCSIS CONTRACTOR 4 83435635194564703
Depanmcnt of Labor & industries
Contractor Registration Section
PO Boz 44450
Olympia WA 98504-4450
N0. 880 P01
REGISTRATION VERIFICATION
(206) 956-5226
SCAN 269-5226
FAX (206) 956-5228
rTu From
08-19-93
Olympia�feaaquarters
Registered name
A.RM8.IR4.Nti.....0 9.N.STRII.CT.I.O.N
Registration number
ARMSTC*192N1
Contractor: Your Certificate of Registration will be sent from the Olympia office and
should be received within 2 to 3 weeks. Please keep this record until you receive your
Certificate of Registration.
P625-036-000 registration verification 4-93
Thank you