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1992, 08-04 Permit App: 92006023 Sewer
GI 2,- (Qo2 q z s- -1 I qz-dozy SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS: CITY/STATE/Z P:" C - GOO PARCEL NUMBER: WJE 7' OWNER: 6(1_,L.2_12/ � ��2�_.-k'_ t �> PHONE NUMBER: yam'/" 9 MAILING ADDRESS: ,Sz-,.4e�"��-E---- (Street) (City/state) (Zip) CONTRACTOR: Coue.0 t#d 4C EXCAVATlot-1 LICENSE NUMBER: 1OUece j81+e? PHONE NUMBER: q a4-54185 MAILING ADDRESS: E. iroyba UA- LEywAY Ove YeePttsALE WA ct9037 (Street) (City/state) (Zip) uJ oLFcee3T DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE /( 44-ez X EACH UNIT =AMOUNT X50.00= J9 e X 35.00 =c-' �. j SUBTOTAL $ g.� `'-, EQUALS: TOTAL PEMIT FEE DUE p _$ (5)6- '-z Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675