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1992, 09-22 Permit App: 92007890 Sewer
• . SEWER/PLUMBING PERMIT APPLICATION FORM g , 60 •Selo INFORMATION WORKSS-IEET JOB STREET ADDRES : CEJ • / Y&7 flf M ` 9 CITY/STATE/ZIP: O PARCEL NUMBER.R 5 <69 O MAILING ADDSS: _..1 OWNER: /7/01-e4-4..."_-• PHONE NUMBER: ��� — 02- 2 0 9 ' 1 %0\ ) (Street) (Citylstate) (Zip) 1 CONTRACTOR:CIou2QkMHE ExClwa riow LICENSE NUMBER: Coo.ecCA�t 181 4.11 &" PHONE NUMBER: gag -641)5 MAILING ADDRESS: E. lb'I22 UAUEyw{1y AVE VeeDALE b✓A- 9,037 (Street) (Citylstate) (Zip) DESCRIPTION SEWER CONNECTInN 'PLUMBING ALTERATIONS SIGNATURE fee County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 X EACH UNIT =AMOUNT X50.00= 3p g X 35.00 = -5-c 92--c? SUBTOTAL 5-4'L-6 $ .331 EQUALS: TOTAL PEMIT FEE DUE =$ &-S O-�7 vols"