1994, 05-24 Permit App: 94004695 Sewer,'P
SEWER CONNECTION PERMIT
*THIS APPLICATION FORM MUST BE FILLED,OUT
SIGNED OR PERMIT WILL NOTc BE ISSUED.
JOB ADDRESS:3' 4 h �[ /9d r—/c.)
CITY: Spokane
OWNER NAME: Deane Anderson
CITY:
PHONE NUMBER: 509-533-0963
STATE: WA
APPLICATION FORM
ACCURATELY AND IN
P--1-
KNOWN)
PARCEL NUMBER:
Ggtfo5
cC t3- 57 Z-
ITS ENTIRETY AND
ZIP CODE: 99223
ADDRESS:
STATE:
same
ZIP CODE:
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION?
YES /N0t
(CIRCLE NE -
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: AIvJGI\IS Ac41 e ADDRESS: (.) NyL 10.154-2.
CITY: Snr a/1Q.
PHONE NUMBER: c122 - B ()En
STATE: '44
ZIP CODE: QGI2lq
STATE CONTRACTORS LICENSE NUMBER: A L.VJ Ai(A i006-, Q S
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS?
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 1 X 50.00 =
INTERIOR PLUMBING ALTERATIONS:$ OF BUILDINGS 1 X 35.00 =
TOTAL PERMIT FEE DUE $
50.00
35.00
85.00
APPLICANT
SIGNATURE:
DATE: 5-20-94
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509)
456-3675