1993, 02-16 Permit App: 93000870 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
3'4 15d n.jC-
JOB STREET ADDRESS:
CITY/STATE/ZIP: SP 61-crNo � CVA PARCEL NUMBER:
MAILING ADDRESS: SA utt. -
OWNER: L.,')6.).\c.vPHONE NUMBER: -'--(0- 1 l 38
(Street) (City/state) (Zip)
CONTRACTOR: H f S Cvnsa-ruc-i-ian LICENSE NUMBER: HSCatJ F
PHONE NUMBER: ct2.(o- 89cDL
MAILING ADDRESS: £.. I I2f tORueyt(' A ki Au€. SPeKRA , IA) Pi. 997.0(0
(Street) (City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE 1
X EACH
UNIT
=AMOUNT
X 50.00 =
co
X 35.00 =
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
=$ cc)
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675
vc
ac Ce