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1992, 06-23 Permit App: 92004634 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET 9z - (o c`> JOB STREET ADDRESS: /77=2.3 •� b3L CITY/STATE/ZIP: PARCEL NUMBER: C12-- MAILING ADDRESS: OWNER: 167./VRA47 '4 PHONE NUMBER: 92 — e9,3" --.R I Kat) � (Street) (City/state) (Zip) CONTRACTOR: , , �, J©,V LICENSE NUMBER: PHONE NUMBER: 9�,--� 7 O MAILING ADDRESS: /-?S/7 . /2" 9e9s4/Ye; 1.2/74 (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT =AMOUNT X 50.00 = / ,s --O_ D TJ X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$ ,...S -D, O SIGNATOR L Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675