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1992, 08-24 Permit App: 92006780 Sewer
SEWER/PLUMBING PERMIT,APPLICATION FORMC� A(Q002:INFORMMATION WORKSHEET p ' _ JOB STREET ADDRESS .5‘ i /a ,� 7 �'- ' v CITY/STATE/ZIP: - 02,0 ' PARCEL NUMBER: MAILING ADDRE S: c.2.—ry<-�__., OWNER: " ' - (ebtA 5 PHONE NUMBER: 7c2 .5.--.O—Lia" (Street) (City/state) (Zip) CONTRACTOR:Gotta-WI E. EXCAVATION LICENSE NUMBER: Cou ecCat.181 k"/ PHONE NUMBER: cla4-S485 MAILING ADDRESS: E. WLjO,? URUEYWAY AVE vseADALE WA- 99037 (Street) (City/state) (Zip) 6 DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE X EACH UNIT =AMOUNT X50.00= `=' X 35.00 =(,.5.51 -re a SUBTOTAL $ 43,5-01/4-e EQUALS: TOTAL--- PEMIT FEE DUE 0-0 _$ Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675