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1992, 10-02 Permit App: 92008384 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET y�7, D Y1 ��_ .46-3L-11.46-3L-11JOB STREET ADDRESS: 5.- 96 $ Ona Iry sr at o'6 e41-- o / ci°1 2 CITY/STATE/ZIP:S 414-1,� PARCEL NUMBER: 111 MAILING ADDRESS: 5 "' 70 el -kr'/4H r,/ ,g A /./„ 9' 9.2 / (Street) (City/state) (Zip) CONTRACTOR: LtrJ / / I i e_ R6 Y LICENSE NUMBER: l.:41/1 % / 12 c.2/"l Pa PHONE d NUMBER: 9 245- - 3 2. 3 MAILING ADDRESS: L` /r5/1 i4/ t "" `` C) t 4 /e ` ". 99l/ 5 7 _ _ _ (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE 4, 4 X EACH UNIT =AMOUNT X50.00= 0 ts X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$ _ 5 0 • Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 \Jo-Ecfr