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1992, 08-21 Permit App: 92006731 Sewer«2S -628)y: SEWER/PLUMBING PERMIT APPLICATION FORM �` 1.e-3 INFORMATION WORKSHEET " / it JOB STREET ADDRESS: 5 / CZ/ 151 e_2 v�� �\° or era CITY/STATE/ZIP: PARCEL NUMBER: � �I LL� (�jtE�� OWNER.. o (�-/ PHONE NUMBER: MAILING ADDRESS: (Street) CONTRACTOR: j/ -<S (City/state) LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS (Street) (City/state) (Zip) X EACH UNIT =AMOUNT X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$ <-44 2c) ,c2 SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675