HomeMy WebLinkAbout1992, 09-16 Permit App: 92007680 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS: o-
�5/ " % 9 OOZ
CITY/STATE/ZIP: > A/rn /tic,)
MAILING ADDRESS: Sr.�
/QJ
OWNER: c 1n - �'c /., r 3 L 6' r
(Street)
CONTRACTOR: H t 5 CONS72UCTlonl
4 WI Or
PARCEL NUMBER: U S a--1 1 • 1 1 �T5
PHONE NUMBER: 9'd'>' 7 r0i2
(City/state) (Zip)
LICENSE NUMBER: HSCON # ' Ia3KF
PHONE NUMBER: 9126 -89404
MAILING ADDRESS: E 11817 VALLEY1did AVE BPok ttse WA g9a0(0
(Street) (City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
X EACH
UNIT
=AMOUNT
X 50.00 =
X 35.00 =
SUBTOTAL
$
J
EQUALS: TOTAL
PEMIT FEE DUE
_$
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!-t
v jr/
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675