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1992, 08-25 Permit App: 92006820 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET K��!d JOB STREET ADDRESS: moi_ 26 a ht /3 a W p / 'V CITY/STATE/ZIP:/04A4' )/e am- 99-UgARCEL NUMBER: 1koW3• J 3e/it- OWNER: 1/: L�4cc PHONE NUMBER: 2� ,>57 MAILING ADDRESS: 2LQ/45e 57d '4J/ , ex -,q 99 Zc (Street) (City/state) (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT =AMOUNT X 50.00 = X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE _$ SIGNATURE Spokane C4unty Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675