HomeMy WebLinkAbout1993, 11-12 Permit App: 93011039 Sewer93 -ico3�
145-1coz.
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.
JOB ADDRESS: �, E KNOWN)
�� �l-P��' J7./'.' PARCEL NUMBER:
CITY: (- STATE: /( � ZIP CODE:
OWNER NAME: 4P74, �r� A -Pt/ ADDRESS:
CITY: STATE: PHONE: 9,_22P --
PROPERTY
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PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES
(CIRCLE ONE)
*IF PROPERTY OWNER' INSTALLING SEWER, THEY MUST FIRST CONTACT THE .UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUER..
CONTRACTOR: k 4 S CO (1.5'+U r in ADDRESS: 1 1 S 11 E Valle_
CITY: NSejQ11e_ STATE: VIA PHONE: SOG - G2.6 • cic12.04,0
STATE CONTRACTORS LICENSE NUMBER..: 145 CON 4 -)E. 123 Kc
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES Aij) (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 / X 50.00 = l%
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $
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APPLICANT
SIGNATURE /q 7i
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675
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