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1993, 04-01 Permit App: 93002017 Sewer
I SEWER/PLUMBING PERMIT APPLICATION FORM G ton INFORMATION WORKSHEET 11 JOB STREET ADDRESS: /7O,4 Ze-v-4-- 2.,•( CITY/STATE IP: i- PARCEL NUMBER: (� _ )9j"( OWNER: V8''-L�`' ( PHONE NUMBER: MAILING ADDRESS: , (Street) , (City/state) (Zip) CONTRACTOR://)�% ..... '.. , , (CENSE NUMBER: �> PHONE NUMBER: 7d---- (-1',&---r-t-- ..3-"‘ MAILING ADDRESS: ' (Street) (City/state) (Zip) 1114,X EACH i-5( DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00 = O ,` �'�O� ) PLUMBING ALTERATIONS X 35.00 = �� Q� SUBTOTAL $ �Gr ' pc �� EQUALS: TOTAL ``�D�' 3 PEMIT FEE DUE _$ W �' SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675