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1992, 09-22 Permit App: 92007933 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS:S/rc C3 CITY/STATE/ZIP:Sil,44-4er c" ; kaitY .)f� OWNERJ/Ic./c 61X411444 )s MAILING ADDRESS: / 3/0 3 Gv //Cent (Street) CONTRACTOR: G 2 7/ie iA J1» PARCEL NUMBER: PHONE NUMBER: IJ V. Kei-2. DL—LSA V)C I/0c.:�4- 9-6/Z & (City/state) (Zip) LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/state) . (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT =AMOUNT X 50.00 = X 35,00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE o$ SI©NATUflE Bpokana Pouniy Bmpartniont df ®uIldIri4a West i 303 Broadway Avenue Bpokana; WA ; 8288 (OW458.8878