1993, 02-16 Permit App: 93000883 Plumbing ReversalSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS:,,fHain P/1
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CITY/STATE/ZIP: SrOkan F 992/6 PARCEL NUMBER:
OWNER: 70latA,Ln'l4CZ/GrPHONE NUMBER:/ / / {
MAILING ADDRESS: S. era 4/ fier kni a, ROceC( .�{�JaL%
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CONTRACTOR: WrL 4e to
t, (Street)
er LICENSE NUMBER: �y_Cef
PHONE NUMBER: Y 2p''2 ,S 0 /
MAILING ADDRESS:
(Street)
(City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE
X EACH
UNIT
=AMOUNT
X 50.00 =
X 35.00 =
1
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
_$
Spokan•. County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675
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