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1994, 01-04 Permit App: 94000071 Sewer
SEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT BE ISSUED. JOB ADDRESS: g2-li S. Mar'tac CITY: ApcpylGtfl L STATE: WA II Glg2�(v OWNER NAME: WilheAon f1r.r.I1cr ADDRESS: CITY: _ �Qu l 1.0 , STATE: WA- PROPERTY �l PROPERTY OWNER PERFORMING SEWER CONNECTIOL N. NS ALLATION? (YES YISCLE (1;17A • (IF KNOWN) PARCEL NUMBER: . O 24'7 ZIP CODE: • or PHONE: *IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT The ,jiiLITiES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS/EI ISSUE. CONTRACTOR: 44, 5 (�nLs4! L.X/,� �©rADDRESS: I I 1% C•v• i R `nin� CITY: fin, STATE: VIA PHONE: 4;724..4;724..- R9/RiLf STATE CONTRACTORS LICENSE NUMBER... /45 CO Ni a-4- X72 UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES INTERIOR ALTERATION WORK BY..: ADDRESS: CITY: STATE: J (CIRCLE ONE) PHONE: LIP ,vE: *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION # OF BUILDINGS / X 50.00 = 25--6)• n o INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 = TOTAL PERMIT FEE DUE $ S t - Cn APPLICANT SIGNATURE "swot SPOKANE ?AUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456 saio�,