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1992, 10-09 Permit App: 92008650 SewerSEWER/PLUMBING PERMIT APPLICATION FORM JOB STREET ADDRESS: CITY/STATE/ZIP: MAILING ADDRESS: OWNER:5o �i-/-1-,E/U - PHONE NUMBER: C:76 q- 7'r,0a (Street) (City/state) CONTRACTOR:X2 C - LICENSE NUMBER: PHONE NUMBER. MAILING ADDRESS: 73y -Y& �' /,2/ -Li • c-- d �YnIF • (Street) City/state) INFORMATION WORKSHEET /,3.29-3 0y j* 6iZS )c)b3 109--11 PARCEL NUMBER: (Zip) c (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE X EACH UNIT =AMOUNT X50.00= SID .00 X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$S-. O0 Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 \22'