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1992, 10-30 Permit App: 92009605 Sewer
SEWER/PLUMBING PERMIT tiPPLICATION FORM WORKSHEET ORKSHEET JOB STREET ADDRESS: ';9 2-3 CITY/STATE/ZIP: Sp GM 92-1(1. OWNER: MAILING ADDRESS: has -1137 E-- Gwith El & -9(005 PARCEL NUMBER: PHONE NUMBER: (Street) CONTRACTOR: ALWMS ACTIVE MAILING ADDRESS: (Street) (City/state) (Zip) LICENSE NUMBER: A( WAY A* 10(295 PHONE NUMBER: qaa- 85e0 19l5ba SPOkANE Wk 99x14 (City/state) (Zip) DESCRIPTION (SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE 1 X EACH UNIT X 50.00 = X 35.00 = BTOTAL =AMOUNT EQUALS: TOTAL PEMIT FEE DUE _$ Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 LLG9-6/51