1993, 08-13 Permit App: 93006949 Sewer.c.54 kr-2-7:6
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1‘ L�7SEWER/PLUMBING PERMIT APPLICATION FORM
44- INFORMATION WORKSHEET
S. 1618 Pines Road
JOB STREET ADDRESS:
CITY/STATE/ZIP: Spokane, WA 99206 PARCEL NUMBER:
OWNER: Pam Pipkin PHONE NUMBER:
MAILING ADDRESS:
035-(0i4
(Street)
CONTRACTOR: ALWMS ACTIVE
MAILING ADDRESS:
(Street)
(City/state) (Zip)
LICENSE NUMBER: At WAY A* 10%PS
PHONE NUMBER: qaa 8.5co
1415ba S•POkANE WA 99a114
(City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
® SIGNATURE
X EACH
UNIT
=AMOUNT
X50.00=
50.00
X 35.00 =
35.00
SUBTOTAL
$ 85.00
EQUALS: TOTAL
PEMIT FEE DUE
=$ 85.00
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675
JJ IWC 1Cl•Ul ♦v•Lnuui♦ v
. •
'03-10-'93 TLE 09!31 I D: TU'L $TER LOCATION. TEL NO: 20ci, 279 5461. 14176 P01
Dopatnan of Lam &
tmmrliasiatadoa Sadao
ro Ono
Olympia Ws 48$044450
REGISTRATION VERIFICATION
(263)9344331
ac�x2608226
MX SOO tvonns
Prom
6isl,
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Contractor: Your Co:dilcate of Registnuion will be sent from the Olympia office and
should bo received within 2 to 3 weeks. Please keep this record until you receive your
Cartago of Raidsoadon.
Thank vats
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