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1993, 08-26 Permit App: 93007539 SewerSEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT BE ISSUED. �_ �"- ( IF KNOWN) JOB ADDRESS: / ) /�% s- �'�'"� L PARCEL NUMBER: STATE:' lel- ZIP CODE: 92/c73) CITY: �� �.� OWNER NAME: STATE: PHONE: 9g /J -© 7` 2 CITY: PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES (CISCLE ONE) ADDRESS: *IF PROPERTY OWNER INSTAGSEWER, THEY MUST REQUIREMENTS BEFOREIRST PERMIOTNISCISSUED.THE TILITIES DEPARTMENT FOR CONSTRUCTION CONTRACTOR: STeA 4& �ONSTP-UOION ADDRESS: CITY: 5P0KR N E- WPr E Ciq a lti ?,0. atak 142 PHONE: q2.6-00559 STATE CONTRACTORS LICENSE NUMBER..: AeMsTC .19 Ns UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES (CIRCLE ONE) -NO- INTERIOR ALTERATION WORK BY..: ADDRESS: PHONE: CITY: STATE: ZIP CODE: *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION # OF BUILDINGS ) X 50.00 = INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 = \� TOTAL PERMIT FEE DUE $ APPLICANT SIGNATURE lop ''') potr6 SPOKANE COUNTY DEPARTMENT WAF99BUILDINGS 260 (509)456-36e� WEST 1026 BROADWAY AVENUE SP