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1992, 06-25 Permit App: 92004738 Plumbing Reversal
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS: 59( CITY/STATE/ZIP: • PARCEL NUMBER: OWNER: ('L- PHONE NUMBER: 9,76 �-��•�.2. �� d--cam--� MAILING ADDRESS: (Street) (City/state) (Zip) CONTRACTOR: CoueC14-itC &IOWA -M.( LICENSE NUMBER: COU e CC )L1191 R? PHONE NUMBER: q a4 -5485 MAILING ADDRESS: E. I4,L ? UA-C.t.EyLAV 4 /e YeeAbALE- WA ci9O37 (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE <���-'"`-6'` X EACH UNIT =AMOUNT X 50.00 = X 35.00 = c,,..' SUBTOTAL $,,, EQUALS: TOTAL PEMIT FEE DUE _$.�� Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675