1992, 10-14 Permit App: 92008869 Sewer,pr_T-12 '92 1T 3gM—R51.1`;10nH FPX928430
-
An \Ouei
SEWER/PLUMBING PERMITTAPPLICATION FORM
INFORMATION WORKSHEET/
JOB STREET ADDRESS: F r
CITYISTATE/ZIP:
OWNER:_
MAILING ADDRESS:
CONTRACTOR: ALwnl5
MAILING ADDRESS;
AT/ c Y e_G -10 Vele
PARCEL NUMBER:
PHONE NUMBER:
(Street)
AcTty e
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE
(Street)
X EACH
UNIT
(City/state) (ZIP)
LICENSE NUMBER: ALWPYA*1O(0P5
PHONE NUMBER: -falai 85e0
f415ba SQokAN€ Wk %la14
(City/state) (ZIP)
P.2
X 50.00
X35.00=
SUBTOTAL
EQUALS: TOTAL.
PEMIT FEE DUE
AMOUNT
4 CO
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99240 (509)456-•3675
0