1994, 05-24 Permit App: 94004694 Sewer SEWER CONNECTION PERMIT APPLICATION FORM
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*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND
SIGNED OR PERMIT WILL NOT BE ISSUED.
1812 S Davis (IF KNOWN)
OB ADDRESS : PARCEL NUMBER:
CITY: Spokane STATE : WA ZIP CODE: 99216
•WNER NAME : David and Karen Bowerman ADDRESS : same
ITY: STATE : ZIP CODE:
'HONE NUMBER: 509-922-4672
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
ONTRACTOR: A k/J 2\r, ADDRESS : -P.0 . yCD'L. 11.41,56,2_
ITY: � � �� STATE: WA ZIP CODE: gcA2ty
PHONE NUMBER: q 22 - S��
TATE CONTRACTORS LICENSE NUMBER: AtL VJ A A 106-, iDS
1UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE)
INTERIOR ALTERATION BY:
ADDRESS : PHONE NUMBER:
CITY: STATE: ZIP CODE:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION • # OF BUILDINGS one X 50 . 00 = 50 . 00
INTERIOR PLUMBING ALTERATIONS : # OF BUILDINGS X 35 . 00 =
TOTAL PERMIT FEE DUE $ 50 . 00
APPLICANT
SIGNATURE: �. � �. DATE: ( '/ "/
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SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675