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1992, 08-06 Permit App: 92006169 Sewer
SEWER/PLUMBING PEPIMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS: 5- Sz3 9D- tel ct5-77 CITY/STATE/ZIP: iCI (,l%r1 , c, 1'L l b OWNER: G4e-v A -P 2f -T7 MAILING ADDRESS: , S Z?j (Street) CONTRACTOR: PARCEL NUMBER: PHONE NUMBER: 9'2--h-- fR 7 / ec (City/state) ' (Zip) LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE X EACH UNIT =AMOUNT X 50.00 = X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE _$ Spokane County Department of Buildings 303 Broadway Avenue Spokane, WA 99260 (509)456-3675 4599x& ( ,9igs