1994, 10-19 Permit App: 94010384 SewerSEWER CONNECTION PERMIT qq `sr I I 19(/..„
PLEASE NOTE: This application form must be filled out accurately and in its entirety, and signed,
or a permit will not be issued.
PROJECT INFORMATION M jLwweesr
APPLICATION FORM
Job address:
Uu
Owner's name: ,
bo 1A IA AR 2Is
Business address:
/3R'fG
/33/9 ET--, MpiE
City: Se O f>g rU
City/State: .Spec K►9
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Zip:/
Zip:
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Parcel number (if known): H 1e5
(4c)1q-l5Jt5rct '
Phone:
I�.8"-3`d'ib
I WIL3 HE PROPERTY OWNER BE P RFORMTNNG THE SEWER CONNECTION
INSTALLATION?*
Yes No
*If property owner is installing the sewer connection, they must first c ntact the UTILITIES DEPARTMENT for construction
requirements before the permit is issued.
CONTRACTOR INFORMATION
Contractor (company name):
772—.C.
State contractor license number:
7GcCoXK/o7M&
Business address:
/3R'fG
- l'g-F--G,
Utilities installers permit number:
City/State: J
/45" (kis-/,,c,1/4-.
Zip: ?9& a
Phone: 9a 7-('76?7
INTERIOR PLUMBING ALTERATIONS (if applicable)••
Contractor (if different from above): Phone:
Business Address:
City/State/Zip:
** For plumbing reversal fee information, see reverse side of this form.
FEE INFORMATION
Sewer Connection: Number of Buildings / X (times) $50 (per bldg) _ $ c5-0 .
TOTAL FEE
(One permit required for each separate building, shop, garage, etc., that will be connected to the sewer)
APPLICANT SIGNATURE:
soniroasa
Date: / D -/9-99
Spokane County Division of Buildings
West 1026 Broadway Avenue * Spokane, Washington 99260 * (509) 456-3675