1992, 12-08 Permit App: 92010775 Plumbing ReversalSEER/PLUMBING PERMIT APPLICATION FORM 2 `I�
W
INFORMATION WORKSHEET 2.t9
JOB STREET ADDRESS: 5.114 C --,(en
CITY/STATE/ZIP: Scakc.ne LAPPA PARCEL NUMBER:
MAILING ADDRESS: Souk
OWNER: Ac slei
PHONE NUMBER: 9 Zai - of 31
(Street) (City/state) (Zip)
CONTRACTOR: H S &&N$ UC1 ror.l LICENSE NUMBER: HSCON ' Ia3 (F
PHONE NUMBER: °126 -89104
MAILING ADDRESS: E 11811 VAu.EYI4/ Ave SPo krtnte 99x010
(Street) (City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE
X EACH
UNIT
=AMOUNT
X 50.00 =
X 35.00 =
3
S
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
=$3S
—
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675