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1993, 12-21 Permit App: 93012078 SewerL -I -SZ --7Z . r 032- L L.LbSt SEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT 8E ISSUED. 934zo18 935 -11 13 (IF KNOWN) JOB ADDRESS: 5/075 ?' e S PARCEL NUMBER: CITY: 90,1A"A-4-c-e STATE: __ ZIP CODE: OWNER NAME: f0 /ra 4,7k/dc-/e ADDRESS `+. 13717 t i nIr n 1I4v -7.0`4" CITY: [-`L'kft../ gqSTATEE: PHONE: PROPERTY OWNER PERFORMING SEWS 3_ PROPERTY YES 6;37f) (CISCLE ONE) *IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT THE .UTILITIES DEPARTMENT FOR CCONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSSUED;. CONTRACTOR: Lot;< -S /% ADDRESS: //4/5- 7.---;,„ STATE: /-? PHONE: %30;:-5---.17e__. ( CITY: ��n,�A-��-r' STATE CONTRACTORS LICENSE NUMBER..: 6Co6e/ CG /$J C UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? NO (CIRCLE ONE) INTERIOR ALTERATION WORK BY..: (`%/k. 22/ " �' --s2 ADDRESS: PHONE: 3z�r 3/ CITY: 5-7b44 STATE:lc),_- 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 = 50 CO INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 = bb TOTAL PERMIT FEE DUE $ APPLICANT SIGNATUR i SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675