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1993, 04-01 Permit App: 93002014 Sewer SEWER/PLUMBING PERMITAPPLICATION FORM �I� INFORMATION WORKSHEET Ce),- 2 r / JOB STREET ADDRESS: ` /70 S`--_.S' �� CITY/STATE/ZIP: PARCEL NUMBER: C1(0 MAILING ADDRESS: /All _/ ' ' GJ OWNER: '9' '/i-D---" PHONE NUMBER: \.12\a�Q (Str t) (City/state) (Zip) V CONTRACTOR ,LICENSE NUMBER: PHONE NUMBER: g2 Y'---05 —y' MAILING ADDRESS: (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00 = PLUMBING ALTERATIONS X 35.00 = SUBTOTAL $ EQUALS: TOTAL / PEMIT FEE DUE =$ 1 j 3 03 SIGNATURE LA- e, ' Spokane County Department of Buildings l� L- West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675