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1993, 03-18 Permit App: 93001610 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS: /go 7 8. /1(C)L5— CITY/STATE/ZIP: OWNER: JAI 2,4/ MAILINPi ADDRESS: PARCEL NUMBER: /, PHONE NUMBER(0pp ) 7.S4' "40/5-7) Street _ CONTRACTOR: T%, (' -. tj 1c MAILING ADDRESS: (City/state) LICENSE NUMBER: PHONE NUMBER: ( TLCCo;f1pok 10-1-19 b (Street) (City/state) (Zip) /G DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT =AMOUNT X 50.00 = SO. 0 0 X 35.00 = *3 St- 0 0 SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE _$ gv/Y) v1/4) o ` sk OPQo, V SIGNATURE✓ t/ 2 Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675