1992, 08-21 Permit App: 92006732 SewerSEWER/PLUMBING PERMIT APPLICATION FORM \.0
JOB STREET ADDRESS: " l 96.% t , h Cf f -S°
INFORMATION WORKSHEET
CITY/STATE/ZIP: !/,OWNER: A. / / jjr../evi PHONE NUMBER:
MAILING ADDRESS: JC-µ
PARCEL NUMBER:
/ c (Street) (City/state) (Zip)
CONTRACTOR: /f " ✓ LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
(Street)
(City/state) (Zip)
X EACH
UNIT
=AMOUNT
X 50.00 =
Sel
X35.00=
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
_$
I_
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675