1993, 03-15 Permit App: 93001492 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS: S /51/9' 0/ V2/ 07-t
et
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CITY/STAT- PARCELONNUMBER:
OWNER: PHONE NUMBER:
MAILIN ADDRESS:
(Street (City/state) (Zip)
CONTRACTORAva - LICENSE NUMBER:
PHONE NUMBER: 9:22----OSC-C7
MAILING ADDRESS:
(Street)
(City/state)
(Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
X EACH
UNIT
=AMOUNT
X 50.00 =
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
6'