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1993, 06-16 Permit App: 93004602 SewerL24;.ig1q -•i'1-1 VCR/ice-Es?' SEWER CONNECTION PERMIT APPLICATION FORM 13 -moo z 9s375 *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT BE ISSUED. JOB ADDRESS: /Zc'?$ , /rA R AJ_ Rd CITY: F 7 STATE: OWNER NAME :QJ\U k T jif tv4)MR Iii CITY:- kf \ 11) E STATE: (IF KNOWN) PARCEL NUMBER: ZIP CODE: ADDRESS: I$ 0O . SIARO S PHONE: ! o`.%- g� io PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES (CIRCLE ONE) *IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED. CONTRACTOR: TLC C©NST2uCTioN ADDRESS: E I381(O 12.1+1 PAVE 2.07 CITY: SPOKANE WA STATE` g9o21(o PHONE: q21- (07100 STATE CONTRACTORS LICENSE NUMBER... TL.000*VE LO1 M to UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES 0" (CIRCLE ONE) 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 1 X 50.00 =,,MAJWIL INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 = $50.0c. TOTAL PERMIT FEE DUE APPLICANT 51GNATURE/�� SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675