1992, 07-13 Permit App: 92005174 SewerSEWER/PLUMBING PERMIT APPLICATION FORM WI'l/
INFORMATION WORKSHEET ((
JOB STREET ADDRESS: E /01903 lwrH4 £ 04
CITY/STATE/ZIP: ..pk c GV/1 ffr/ PARCEL NUMBER:4 S a -7z ,e q Pte
ADDRESS: ���t),� UT' WE .5;00 kAl/� 104 T91-
OWNER:
MAILING
ea 6,�/EAr/ PHONE NUMBER: 9 D-� — S S a
tQL,
(Street) (City/state) (Zip)` //
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Zip)
(Street)
(City/state)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE
X EACH
UNIT
=AMOUNT
X 50.00 =
X 35.00 =
SUBTOTAL
$
EQUALS: TOTAL
PEMITAFEE DUE
=$
iSpokan County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675