1994, 06-08 Permit App: 94005567 SewerSEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM
SIGNED OR PERMIT WILL
JOB ADDRESS: h 1 3
CITY:SOKON1.�
OWNER NAME : %&'t
Vie,
MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND
NOT BE ISSUED.
VC \Cul
STATE: R
C Me LL
CITY: 'flO L STATE:
PHONE NUMBER: ( -gO L Cp
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION?
(IF KNOWN)
PARCEL NUMBER:
ZIP CODE:
ADDRESS:
ZIP CODE:
YES
(CIRCLE
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: 7L..C. Cp fS-hrj, ±con
ADDRESS: 13citb E • t2-4 4/L.
CITY: ,S,/1ckzn n P� STATE:
ZIP CODE: GI Ci Zt (m
PHONE NUMBER: 9 Zfl -
STATE CONTRACTORS LICENSE NUMBER: G C O * 1 M %-
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES
INTERIOR ALTERATION BY:
ADDRESS:
CITY: STATE: ZIP CODE:
NO (CIRCLE ONE)
PHONE NUMBER:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION •# OF BUILDINGS / X 50.00 = ,6-7) 067
INTERIOR PLUMBING ALTERATIONS:# OF BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $ 1-)0 0 0
APPLICANT
SIGNATURE:
DATE:
6-2-94
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675