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1992, 07-28 Permit App: 92005793 Sewer
SEWER/PLUMBING PEPMIT'APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS: /77/ _C. /CIA/ES' ter/ CITY/STATE/ZIP: PARCEL NUMBER: �J OWNER://YI D/ '0PHONE NUMBER: 9�.� �9�� ` 1 (CS deg 7 MAILING ADDRESS: c,2 (Street) (City/state) (Zip) C,�z_51 1 CONTRACTOR: / �• LICENSE NUMBER: 7 �j G7 per/ PHONE NUMBER; -Z- -/�O/lJy `` � MAILING ADDRESS: /sS € %E � _ . ?/>IS47At�` �A • 906 (Street) ( ity/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE X EACH UNIT =AMOUNT X 50.00 = _CO . O a X35.00= 3-s, Oo SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE S/�e a =$ j� Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675