1992, 07-08 Permit App: 92005092 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS: /. / / d 5" ✓/' G/9v /' r-19/
CITY/STAT�/�/ iP: o// PARCEL NUMBER: / `� /
OWNER/77,.. Gl) o • 13 PHONE NUMBER: Yo7� 7�� b
MAILING ADDRESS: 541/4c-
(Stre t) (City/state) (Zip).
CONTRACTOR:// 5 1 n cin< LICENSE NUMBER: /_ S Cons/
s/
PHONE NUMBER:
MAILING ADDRESS: %%62% ad LA7 ei.)
(Street) 0 6 (City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
X EACH
UNIT
=4AOUNT
X 50.00 =
t
X35.00=•
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
=$ CU
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675
Q
V /