1993, 10-29 Permit App: 93010461 Plumbing Reversal14.5z73, 2?&) = (13-040
f{i(lt(em, At rl
13s -937
t8,
SEWER CONNECTION PERMIT APPLICATION FORM a3
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS EN�ToI 4
AND SIGNED OR PERMIT WILL NOT BE ISSUED.
JOB ADDRESS:
2609 S. Pines
CITY: Spokane
OWNER NAME: Robert Numata
(IF KNOWN)
PARCEL NUMBER: 27543-2801
STATE: WA ZIP CODE: 99206
ADDRESS: S. 4891 Bnwdich
CITY:
Spokane STATE: WA
PHONE: 924-6449
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES
(CISCLE 0 E)
*IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: JEPSEN'S SEWER HOOK UP
CITY:
Spokane, WA 99206
ADDRESS: S. 509 Bowdish
STATE: PHONE:
STATE CONTRACTORS LICENSE NUMBER..:
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS?
INTERIOR ALTERATION WORK BY..:
ADDRESS: N. 4113 Molter
JEPSESH081JB
928-0154
JSPLU107QL
NO (CIRCLE ONE)
Jim Burger (Jim's J&S Plumbing)
PHONE: 928,-9444
CITY: Otis Orchards STATE: WA ZIP CODE:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC
THAT WILL BE CONNECTED TO THE SEWER.
SEWER CONNECTION : # OF BUILDINGS 1 X 50.00 = 50•on
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS ( X 35.00 = ,35.00D,
TOTAL PERMIT FEE DUE $ 25.cn
APPLICANT
SIGNATURE
)2ke,
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675