1992, 08-18 Permit App: 92006527 SewerSEWER/PLUMBING PERMIT APPLICATION FORM c!
INFORMATION WORKSHEET
JOB STREET ADDRESS: ;�, 3 a a 3 a
CITY/STATE/ZIP: PARCEL NUMBER: 45 "q . 0'70,7
MAILING ADDRESS:
OWNER: _ _ PHONE NUMBER: xK a�
(Street) (City/state) (Zip)
CONTRACTOR: NC-i1kk-' LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
X EACH
UNIT =AMOUNT
X 50.00 =
X 35.00 =
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE =$
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675