1992, 07-27 Permit App: 92005770 Seweri -
X23 ,Cb EWER/PLUMBING PEF AIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADD SS:
CITY/STATE/ZIP•
MAILING A D ES :
OWNER: 11 - Aar
/ Q CL)*
/7
//p PARCEL NUMBER:
aas 'tS7
qD —97 -Th
-2-577(
CONTRACTOR
�-/GCS-,�- G • f s �0��� PHONE NUMBER:
MAILING ADDRESS: '�' d1G'X S.LI7A `%MQiwc n
.PHONE NUMBER: 0&
(street) t r t t.C, /J.J .(City/state) 9 g/ 9 (Zip)
LICENSE NUMBER: ! / 3 T
/990
(Street) (City/state)
(Zip)
DESCRIPTION
'SEWER CONNECTION
'PLUMBING ALTERATIONS
SIGNATUR
O/I
Spokane Coun
West 1303 Broadway Aver
X EACH
UNIT
=AMOUNT
X 50.00 =
/
.5Q • 0-0
X 35.00 =
/
35 • Cl,
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
4
=$ CJ5
,C It Lit a
Department of Buildings
e Spokane, WA 99260 (509)456-3675
99.703