1993, 09-09 Permit App: 93008139 Sewer• SEWER/PLUMBING PERMIVAPPLICATION FORM?
IINNFORMATION WORKSHEET
JOB STREET ADDRESS:______ Z 2. �.(p �S_ Fit A.)1- S
CITY/STATE/ZIP:_ Sp_ ,- - PARCCLNUMBER:_._
MAILING ADDRESS:__
^_ -- (Street) (Zip) /`
ie ^tv�sialel Zig
CONTRACTOR e).th.5�1,�'� LICENSE NUMBER: - TOMSt `1Li'
PHONi. NUMBER: c) --5---n.1
MAILINGADDRESS.__I2....__14_. r1wLG2/2-/D
(Streets (City/state) (Zip)
!X EACH
DESCRIPTION !UNIT
'SEWER CONNECTION X 50.00 =
tPLUMBING ALTERATIONS 35.00 =
SUBTOTAL
EALS fOlAL.
IOIJPEMIT FEL DUE
SIGNATURE
= AMOUNT 9J.
5c7
SO ° 0
Spokane County Douannu:nt of buildings
West 1303 Broadway Avenue Spokane. WA 9926Q(50B)456-3675
nuu-el—,J I- K I U7:17 I L: I UI9WH I tK LUUH I 1 U.V .
Department of Labor er industries
Contractor Registration Section
PO sox 44450
Olympia WA 98504•4450
ItL NU:e0b GJ7 54b1 144bd I'bl
REGISTRATION VERIFICATION
(206) 956-5226
SCAN 269-5226
PAX (206)956-5228
�lb
liegIstereanima
EXPIRES: TOM STONE EXCAVATING
oiym to 2 6 956-5214
4-25-94 s TOMSTE*141KM
Contractor: Your Certificate of Registration will be sent firm the Olympia office and
should be received within 2 to 3 weeks. Please keep this record until you receive your
Certificate of Registration.
Tkan& you
P625-036-000 regimrodmverifiadm 4-93