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1992, 10-14 Permit App: 92008618 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS: Ro I J (.-)5' �n r CITY/STATE/ZIP: qq42\te PARCEL NUMBER: PHONE NUMBER: OWNER: AM/1(6- 6 MAILING ADDRESS:(SStreet) (City/state) (Zip) CONTRACTOR: ALLOhl5 ACYIVE LICENSE NUMBER: q NUMBER: ALIA/ AY a- $5�10(oP5 PHO NS 925 " /e45 MAILING ADDRESS: -60IL /4i5ba SPOkANE WA qqa 14 (Street) (City/state) (Zip) DESCRIPTION X EACH UNIT X 35.00 X 50.00 = = (SEWER CONNECTION PLUMBING ALTERATIONS SUBTOTAL SIGNATURE =AMOUNT EQUALS: TOTAL PEMIT FEE DUE =$ 0O Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675