1992, 11-30 Permit App: 92010459 SewerSEWER/PLUMBING PERMIT APPLICATION FORMl
INFORMATION WORKSHEET CA a _ 1' `
JOB STREET ADDRESS: J • -) 0-1 G( e n 9- \U
CITY/STATE/ZIP: Sf � icc, , ;, rfl PARCEL NUMBER:
MAILING ADDRESS: 'uy LAC
OWNER: o!.te,,
(Street)
PHONE NUMBER: L`( i 3 5
(City/state) (Zip)
CONTRACTOR: H S Cons{-rucl-icon LICENSE NUMBER: HSCa,J ► Z1 1C F
PHONE NUMBER: et '?...(1).- 85my
MAILING ADDRESS: E • UAu.eyway AuE. SPeKAkkr., uJ A. 99Z,ol15
(Street) (City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE
X EACH
UNIT
=AMOUNT
X50.00=
1
X 35.00 =
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
=$
`: to
pdkane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675