1993, 02-02 Permit App: 93000573 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS: �' RIC
CITY/STATE/ZIP: PARCEL NUMBER:
MAILING ADDRESS:
OWNER: lAS to D PHONE NUMBER:
3- 573
((Stre�e—t) (City/state) . (Zip)
CONTRACTOR: �)Y�V LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street)
(City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
X EACH
UNIT
=AMOUNT
X50.00=
C -L -)C)
X 35.00 --
SUBTOTAL
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
_$
()
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane. WA 99280 (509)456-3675