1994, 10-14 Permit App: 94010205 Sewer05/31/1993 19:23 509-9284306
({4- TT CA foci
SEWER CONNECTION PERMIT (146 " 1)'x"2'
APPLICATION FORM
PLEASE NOTE: This application form must be filled out accurately and in its entirety, and sigrr !_
or a permit will not be issued.
RON SLOAN PAGE 01
PROJECT INFORMATION
Job address:
zV /0a2 tie And
City: -moo (owe
Zip: 99)/ /n
Owner's name:
Parcel number cu> known):
City/State:
Zip:
Phone:
/3UC,C
WILL THE PROPERTY OWNER BE PERFORMING THE SEWER CONNECTION
INSTALLATION?' Yes / No
vfproperty owner it installing the sewer connection, thry mgrs first contact the UTILITIES DEPARTMENT for construction
requirements before the permit is issued.
CONTRACTOR INFORMATION
Contractor (company name):
State contractor license number
ALV Va *i L.P
Business address:
PO (?)(3)t IU1S(e2.
City/State: r ....rho vJA
Zip: G c12.441 Phone: 90_, - F3 6 co
Utilities installers permit number:
INTERIOR PLUMBING ALTERATIONS (if applicable)"
Contractor (if different from above): P
Business Address:
City/State/Zip:
" For plumbing reversal fee information, see reverse side of this form.
FEE INFORMATION
Sewer Connection: Number of Buildings X (times) $50 (per bldg) = $ -SC...
TOTAL FEE
(One permit required for each separate bul , s p, y tat will be connected to the sewer)
APPLICANT SIGNATURE: / Date: /47, /
Spokane County Division of Buildings
West 1026 Broadway Avenue ' Spokane, Washington 99260 ` (509) 456-3675