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1992, 09-04 Permit App: 92007251 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM - � 6/7 INFORMATION WORKSHEET JOB STREET ADDR SS: � Y/6 CITY/STATE/ZIP:(, ,'' 6._.c-)czo MAILING ADDRESS: GC`s c75 -� has-g�� PARCEL NUMBER: OWNER: iC- (p, L*.' PHONE NUMBER: 9t..›2 /76 (Street) ' (City/state) (Zip) CONTRACTOR:Q Ue MNE EXCAvaT1DN LICENSE NUMBER: COu ecCat 15.1411 PHONE NUMBER: cta f -64S5 E. 142410,2 UAuEyw,ay {AVE vee ca -L WA- 4=1,037 (Street) (City/state) (Zip) MAILING ADDRESS: DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS Ir SIGNATURE X EACH UNIT =AMOUNT X 50.00 = X5`-21 d7-`' X 35.00 = -„- SUBTOTAL $ 6,_,..t5_, `` , EQUALS: TOTAL PEMIT FEE DUE _$ afr•J 0-0 — Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675