1992, 08-27 Permit App: 92006921 Sewerqz- (06(a(
SEWER/PLUMBING PERMIT APPLICATION FORM
JOB STREET ADDRE S:
INFORMATION WORKSHEET
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PARCEL NUMBER: ,o7#?/- •?/".-, 7'.-----si 2- -01
MAILING ADDRESS: 9 c)-
CITY/STATE/ZIP. C C -al
OWNER: i ( i e ,-__-•,e)‘-,,... PHONE NUMBER: C. ----------
(Street) (City/state) (Zip)
CONTRACTOR:aueCI4PANE. EXCAViseTIod LICENSE NUMBER: Cou cC At. IBA 0..."/
PHONE NUMBER: claq-64/35
MAILING ADDRESS: E. iblia.? ww.eywiek V IN VE Ve-eADA-Le 14/,4- 9903 7
(Street) (City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
11' 11
r
SIGNATURE
e:61
X EACH
UNIT
=AMOUNT
X 50.00 =
X 35.00 =
SUBTOTAL
$ e5,....5- f.-'
EQUALS: TOTAL
tMiI FEE DUE
- -
.
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456_3675
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