1992, 07-27 Permit App: 92005741 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION 1`:ORKSHEET
JOB STREET ADDRESS: G. 13) /'
CITY/STATE/ZIP 'fir, . L? 1 i1
OWNER:BUHLr - KRiFI//J� PHONE NUMBER:
MAILING ADDRESS: E- /c iJ 7 Y"nac/«c-/ 1)0 •
6u4iir, c
Or .
PARCEL NUMBER:
(Street)
CONTRACTOR:\ S
CFY(*) c
(City/state) (Zip)
LICENSE NUMBER: (r / pis c O atamh
PHONE NUMBER: C(
MAILING ADDRESS: E. I K<%oGr! c-, i C7)o (/(/. RX
(Street) (City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
X EACH
UNIT
=AMOUNT
X 50.00 = L. -----
X
X 35.00 =
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
=$
SIGNATURE4AO/l{Y) 4./n -L
pokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675