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1992, 06-23 Permit App: 92004635 Sewer
t -1S ` SEWER/PLUMBING PERMIT APPLICATION FORM 1-11611`'.--(171`1INFORMATION WORKSHEET JOB STREET ADDRESS: ! c2 e ()2 �• C1 �j�j E' CITY/STATE/ZIP: PARCEL NUMBER: MAILING ADDRESS: 9,5- Cosa q --4(0,3s WV° OWNER: Z)uelL,�y ic.�'&E' !S // Street CONTRACTOR: Ais srr MAILING ADDRESS: /9g'/4 T (Street) PHONE NUMBER: 9.2 G vs' (City/state) (Zip) LICENSE NUMBER: PHONE NUM ER: - - r • /03-/--/ Z 1 7924 ity/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATUR X EACH UNIT =AMOUNT X 50.00 = / X 35.00 = S''v, I, 15 SUBTOTAL $ EQUALS: TOTAL PENT FEE DUE =$ ‘529. ©ej Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675