1993, 10-15 Permit App: 93009886 Plumbing ReversalL4c3z�t•t U
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SEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN
AND SIGNED OR PERMIT WILL NOT BE ISSUED.
JOB ADDRESS: 3‘'/lr^22�'
STATE:J-
OWNER NAME:
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933 - g'72
ITS ENTIRETY
(IF KNOWN)
PARCEL NUMBER:
ZIP CODE:
ADDRESS:
CITY: STATE: PHONE:
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: ARMST►2oN& OoNSTP_UCnoN ADDRESS:
CITY: SPo►«NE. kA) Pic STATE: i '1
?,o. Bak X4282.
PHONE: g2.6-0559
STATE CONTRACTORS LICENSE NUMBER..: AeMSTC*19a N1
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? NO (CIRCLE ONE)
INTERIOR ALTERATION WORK BY..:
ADDRESS: PHONE:
CITY: STATE: ZIP CODE:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC
THAT WILL BE CONNECTED TO THE SEWER.
SEWER CONNECTION
# OF BUILDINGS
l
X 50.90 = L q
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 = q
TOTAL PERMIT FEE DUE $� ,
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APPLICANT
SIGNATURE
4
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675