1992, 09-18 Permit App: 92007831 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
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INFORMATION WORKSHEET
JOB STREET ADDRESS: S. IS34 I--tc CcLq
CITY/STATE/ZIP: Spcksm, USA• PARCEL NUMBER: 457-% / 0 1`z,Sc' 63
MAILING ADDRESS: SAi.nE
OWNER: Iza..nA.rtel RATA
PHONE NUMBER:
(Street) (City/state) (Zip)
CONTRACTOR: H E 5 QoN5712LtCTrot4 LICENSE NUMBER: HSCON i'* I23KF
PHONE NUMBER: x126-89% LJ
MAILING ADDRESS: E 1/8)7 UALLEy4J v AVE SPOkANe I.JA 99x0%
(Street) (City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
X EACH
UNIT
=AMOUNT
X50.00=
cc3
X 35.00 =
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
_$
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675