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1992, 10-06 Permit App: 92008482 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS: flcA, CITY/STATE/ZIP: Vey' cl \-L cSO1 PARCEL NUMBER: MAILING ADDRESS: OWNER: /4Y- n -e 1 • CONTRACTOR: 54 MAILING ADDRESS: (A) C)C1 R PHONE NUMBER: a_ (Street) (City/state) (Zip) (2k V\d4:v--3Ton LICENSE NUMBER: PHONE NUMBER: 9D--2- - -1- C`i 4 15 ji-) HN Cli-c..-u,A cu:_re,s (A)c.', cf 9 (Street) -J (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT =AMOUNT X 50.00 = X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$ SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675