1992, 07-21 Permit App: 92005558 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
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s
JOB STREET ADDRESS: , z Z Lib (-5f-f/
CITY/STATE/ZIP:K. to/i� 9?2 ,PARCEL NUMBER:
MAILING ADDRESSS4\,\
OWNER:
CONTRACTOR:
MAILING ADDRESS:
(Street)
- —iaco.)b(s,
(City/state) (Zip)
PHONE NUMBER: 922 - ZS"j 9
(City/state) (Zip)
LICENSE NUMBER:
PHONE NUM ER: 32.?
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42,5 /7Zt"(,
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DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
X EACH
UNIT
=AMOUNT
X50.00= 1
SO, (19O
X35.00= t
DO
SUBTOTAL
$ 85, DO
EQUALS: TOTAL
P,IT FEE DUE
=$ ,, °O
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675