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1992, 08-18 Permit App: 92006547 Sewer
o\ U547 SEWER/PLUMBING PEI3MIT'APPLICATION FORM INFORMAIION WORKSHEET C12�/ JOB STREET ADDRESS: `j l0-5-1 5 nnf41 e1 Y! CITSTATE/ZIP5 ljt___ic*R)- . PARCEL NUMBER: /� MAILING ADDRESS: �\ /� �\ (Street) (City/state) (Zip) CONTRACTOR na_SLICENSE NUMBER:TO_M EJ (4.1K-rn PHONE NUU�M'BER:.—a22--y1�1-lp ---- MAILING ADDRESS: Pa_`L3x 14 k51--) J . CJI �-+` `'7-192_he (Street) (City/state) (Zip) • DESCRIPTION [SEWER CONNECTION (PLUMBING ALTERATIONS X EACH LkS(7-1. EM1�S UNIT =AMOUNT J SES �lICNe-� X50.00= X35.00= L`���� �'{DC�-^r`C To, C53 SUBTOTAL EQUALS: TOTAL PEIT FEE DUE, ,_6 111 SIGNATURE kt4‘,? •tc-zL-_ okane County Department of Buildings Wesi 1303 Broadway Avenue Spokane -WA 99260 (509)456F-3675