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1992, 10-29 Permit App: 92009523 Sewer
SEWER/PLUMBING PERMF APPLICATION FORM INFORMATION WORKSHEET e'•e/, /7.-- O c7 JOB STREET ADDRES : `z, -a--- - / /(7.) 5 CITY/STATE/ZIP: --)-c - e, -)c";; - PARCEL NUMBER: OWNER:lier ,_' __>-1 (21 ' L PHONE NUMBER: 9c...2,3 - MAILING ADDRESS: (Street) (City/state) (Zip) CONTRACTOR: Q_LteNkitve, E.3(CAttArioN LICENSE NUMBER: auecc-Aki.sigi PHONE NUMBER: 414:W -5s-185 MAILING ADDRESS: E.. Icatiota VALLeytAnIty Nvs VERAbrox WA C19037 (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE fp X EACH UNIT =AMOUNT X 50.00 = X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE .$ Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675