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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