1994, 05-24 Permit App: 94004679 SewerSEWER CONNECTION PERMIT APPLICATION FORM
1415 - (5"7/
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND
SIGNED OR PERMIT WILL NOT BE ISSUED.
(IF KNOWN)
JOB ADDRESS: 2406 South Pines PARCEL NUMBER:
CITY: Spokane STATE: WA ZIP CODE: 99206
OWNER NAME: Robert Numata ADDRESS: S. 4821 Bowdish
CITY: Spokane STATE: WA ZIP CODE: 99206
PHONE NUMBER: 924-6449
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES 676;5
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR:Jr Sef\'4 ConGtau^tion
CITY: <4lczl4anr STATE: V,ia ZIP CODE: `X{206
ADDRESS: <SOGf Ls. SctJd,.Sh
PHONE NUMBER: cite - 01.5q
STATE CONTRACTORS LICENSE NUMBER:
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE)
INTERIOR ALTERATION BY:
ADDRESS: PHONE NUMBER:
CITY: STATE: ZIP CODE:
JEPSE C*060JB
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION -# OF BUILDINGS X 50.00 =
INTERIOR PLUMBING ALTERATIONS:# OF BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $
APPLICANT
SIGNATURE:
DATE: 5.--29 -951
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675