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1992, 06-18 Permit App: 92004504 SewerSEWER/PLUMBING PERMIT APPLICATION FORM 92,- LASOS 05(4 JOB STREET ADDRESS: INFORMATION WORKSHEET CITY/STA E/ZIP: PARCEL NUMBER: OWNER. ••� e S e PHONE NUMBER:�� 7� cl A/��jj MAILI ADDRESS: (Street) (City/state) (Zip) CONTRACTOR: H r S &NSteUCYION LICENSE NUMBER: HSCON•IE*123KF PHONE NUMBER: q 2l0 - 89 (014 MAILING ADDRESS: C. 1181'] UALLE'WAy AYE SPOkLANE WA clgaOlo (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT =MOUNT X 50.00 = X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE _$ � 6 SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675