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1992, 09-08 Permit App: 92007306 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WONKSHEET JOB STREET ADDRESS: /7c2_ S , /1/2e --C-74)..,8 CITY/STATE/ZIP ,7 ZA// / PARCEL NUMBER: OWNER: PHONE NUMBER: 9 ? /S 6, MAILING ADDRESS: —�—' (Street) CONTRACTOR: / . l . MAILING ADDRESS: (City/state) LICENSE NUMBER: / PHONE NUMBER: n, ,A7-'(� 76 O (Zip) (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATUR X EACH UNIT =AMOUNT X50.00= �0, D X 35.00 = 3 �-, 0 p SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$ 8,_.7. 0 0 Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675