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1993, 06-24 Permit App: 93005007 Plumbing Reversal5oo7 SEWER/PLUMBING PERMIT APPLICATION FORM 1INNFORMATION WORKSHEET ^/ JOB STREET ADDRESS: co.`� 71`J elk���'" qLD CITY/STATE/ZIP: CiC(Z� PARCEL NUMBER: PHONE NUMBER: IL2 4 5 0 0 OWNER: CI; ‘•\• MAILING ADDRESS: Il& •l (Stree (City/state) (Zip) CONTRACTOR: ALGOMS ACT1VE LICENSE NUMBER: AI 1.AJAYAaA-10/0"5 • PHONE NUMBER: Q- 85W MAILING ADDRESS: -0. K 191542 SPOkANE Wk qqa 114 (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT =AMOUNT X 50.00 = X 35.00 = SUBTOTAL $ EOUALS:TOTAL PEMIT FEE DUE _$ �� - SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675