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1992, 08-27 Permit App: 92006921 Sewerqz- (06(a( SEWER/PLUMBING PERMIT APPLICATION FORM JOB STREET ADDRE S: INFORMATION WORKSHEET ;2 cia5-Y5.5 1 --,..._ 3—'e.i"-• , .--- c_ _ • 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 ZC C L.24)716" ,99Z ec >t._) c B47 (-1