1992, 08-12 Permit App: 92006367 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS: /cQ 0 6
CITY/STATE/ZIP:,PARCEL NUMBER:p
OWNER -i -C- ��'��� C�� PHONE NUMBER: y 1 e rg->" o 3
MAILING ADDRESS:
(Street) (City/state) (Zip)
CONTRACTOR: CoutCHAriMIE EXCAVATION LICENSE NUMBER: COU ec X161 e'1
PHONE NUMBER: q 24-5485
MAILING ADDRESS: E. Ifc40a VAuegWAY Aye vEefkbALE WA (19037
(Street) (City/state) (Zip)
qz- Ce 36)7
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE ( / - Cie C
X EACH
UNIT
=AMOUNT
X50.00=
,0 O a_c
X35.00=
ea.5 '2
SUBTOTAL
$ `"'"--c)
EQUALS: TOTAL
PEMIT FEE DUE
4,7-K6-
(�� cf-O
_$ O d
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675
a@A ctt)145
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