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1992, 10-29 Permit App: 92009517 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM c`as- INFORMATION / WORKSHEET JOB STREET ADDRES - r0 0 6 - CITY/STATTE//ZIP�r L - 6-2-kP ' PARCEL NUMBER: OWNER: Y\Je S69 > PHONE NUMBER: 90-1-4L— ` // , / MAILING ADDRESS: (/�� � �� (Street) (City/state) (Zip) CONTRACTOR: QEU2P.NAINE eiCHt'RfION LICENSE NUMBER: CIDU .CC'''1$1.f?1 PHONE NUMBER: gag -5'485 MAILING ADDRESS: E.- I(0q©oZ VALLEytclPcy PkVFa VEe,bALE WA M037 (Street) (City/state) (Zip) M 6;o 9 Ra \ DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE ' a Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 X EACH UNIT =AMOUNT X 50.00 = 6) 02-0 X 35.00 = . �;5.0 2 SUBTOTAL $ 7i:5 —" EQUALS: TOTAL PEMIT FEE DUE =$ $�" " cr25 .-ll2ts