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1992, 10-09 Permit App: 92008645 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM /I_NFORMATION WORKSHEET JOB STREET ADDRESS: /�"' o jfS--G-J/✓I C�hJ CITY/STATE/ZIP: PARCEL NUMBER: MAILING ADDRESS;OWNER GIfsL j/ %nc/d PHONE NUMBER: 93F (Street) (City/state) (Zip) CONTRACTOR: / . j . C _ LICENSE NUMBER: PHONE NUMBER: _ MAILING ADDRESS: l S)',6, - /,= 4 $ c prt),�/ Cif,.9 . (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT =AMOUNT X 50.00 = 5-6. C. -DO X 35.00 = ,.3 5 • c..:u (._) SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE 1 �.�.J 0() SIGNATURE- Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 kiJcLcCi.