HomeMy WebLinkAbout1994, 03-25 Permit App: 94002423 Sewer94 2-L42-3
*THIS
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SEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND
SIGNED OR PERMIT WILL NOT BE ISSUED.
:-.51/1:42.2 i)1/. °).0 �� (IF PARCELNUMBER:O
WN)
JOB ADDRES �J
CITY: STATE: ` 2 ii,- ZIP CODE: C.-,.(?/‘
r"-ThOWNER NAME: ,./e9-„, ,C,4: ADDRESS: ,
CITY:
STATE: ZIP CODE:
PHONE NUMBER: gss70
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES aO%
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT I5 ISSUED.
CONTRACTOR: A(Ons-3-ro i Con4ft' A(;hon ADDRESS: -P o . 11-1-2,F3
2.
CITY: S , cuv.... STATE: VJ,4 ZIP CODE: q a ti L
PHONE NUMBER: CP • OSSA"
STATE CONTRACTORS LICENSE NUMBER: AAM T C� 1 G Z of i
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES (CIRCLE ONE)
INTERIOR ALTERATION BY:
ADDRESS:
CITY:
PHONE NUMBER:
STATE:
ZIP CODE:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION .# OF BUILDINGS X 50.00 = �S`v
INTERIOR PLUMBING ALTERATIONS:# OF BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $ `2•
APPLICANT
SIGNATURE:
DATE:
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675