1992, 10-27 Permit App: 92009405 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
MAILING ADDRESS: 1-ce
OWNER: kir PHONE NUMBER:
(Street)
(City/state) (Zip)
CONTRACTOR: H S Cuns1-ruc LICENSE NUMBER: FISC:30 kr- '- F
PHONE NUMBER: ct Zcs- rico U_
MAILING ADDRESS: E . 1 1217 JALL y d AuE. SPaKRIOC.. U1 A. 99Zoo
(Street) (City/state) (Z!p)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE
X EACH
UNIT
=AMOUNT
X 50.00 =
X 35.00 =
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
_$
k,u' tea, g°\-3-1
i
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675