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1993, 10-29 Permit App: 9301469 SewerL-1-5271.113� 4)-i aqt 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. ZIP (IF KNOWN) JOB ADDRESS: 5,/5/c- e�S L GP i�� PARCEL NUMBER: CITY: ��" 94q STATE: CL)a ZIP CODE: l c7//4 ZZ 0 c�/ OWNER NAME: --4 ADDRESS: CITY: STATE: PHONE: 9c7i PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES ANO (CIRCLE ONE) *IF PROPERTY OWNER 'INSTALLING SEWER, THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED. CONTRACTOR: 1445 CO n.5-r(u r iinn ADDRESS: 1 S # 1 E . Vane_ CITY: -6ilakOYsGU1e. STATE: WA PHONE: 5041 • q26 • c3. qq 2.© STATE CONTRACTORS LICENSE NUMBER..: N'S CON 44 4- 123 K� UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES (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 X 50.00 = INTERIOR PLUMBING ALTERATIONS: ## OF BUILDINGS X 35.00 TOTAL PERMIT FEE DUE APPLICANT SIGNATURE !lya.e SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675