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1992, 11-18 Permit App: 92010117 Plumbing Reversal
pie t, y` SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET 2--\ \c\ JOB STREET ADDRESS: O. 700 0 l nT9 (/I'Ieie 0\31 CITY/STATE/ZIP:�3"fl(C4Ai (NA no/6 PARCEL N�U"MBER: �Co��/. (3a9 MAILING ADDRESS: . 70'? 04A+ma.E`/( . Y 6 KtinrC / (N NW,99a / (o (Street) (City/state) (Zip) CONTRACTOR: OWN E(R LICENSE NUMBER: PHONE NUMBER: 902F - 8.3.90 MAILING ADDRESS: (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE diGGd 71 X EACH UNIT =AMOUNT X50.00= X 35.00 = 3 Sa 0 0 SUBTOTAL $ EQUALS: TOTAL PEMITFEEDUE =$ 3S'.,D0 Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675