1992, 09-18 Permit App: 92007832 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS: E.
1ZYc�Z Gc./ Itdie
CITY/STATE/ZIP: Spe, kar a,
MAILING ADDRESS: SOme
OWNER: Bot., KA; pp
Wim. PARCEL NUMBER:
(Street)
CONTRACTOR: H E S C0NS712UCTON( LICENSE NUMBER: HSCON.41',V 123KF.
PHONE NUMBER:
(City/state) (Zip)
PHONE NUMBER: q26-8%4
MAILING ADDRESS: E 118)T LLE V1410 AVE BPOk+4NE WA gq,go
(Street) (City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
X EACH
UNIT
=AMOUNT
X50.00=
Su—
X 35.00 =
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
=$
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675