Loading...
1994, 03-28 Permit App: 94002490 Plumbing Reversal*THIS APPLICATION SIGNED OR PERMIT JOB ADDRESS: S 714.1 ✓►aa rs -M +ca. �Sz�a�l• Iaoz- SEWER CONNECTION PERMIT APPLICATION FORM in (crcPp% FORM MUST BE FILLED WILL NOT /BE ISSUED. Z(6itl AAit--5 STATE : taj AS (4 OWNER NAME: C.l (L/Lci PAS5714026 CITY: t*DO(l444.J6: STATE: t.J 4 PHONE NUMBER: PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO (CIRCLE 0 CITY: 5cicaoc-t-ree Roe: 3z(p gni — vi ci r OUT ACCURATELY AND IN ITS ENTIRETY AND (IF KNOWN) PARCEL NUMBER: ZIP CODE: ADDRESS : 5 — 2-444 R N E 5 ZIP CODE: *IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR, CONSTRUCTION REQUIREMENTS BEFORE PERMIT I5 ISSUED. CONTRACTOR(I A)ni 41/70C, r(J-Kkirl 1'i t1G� ADDRESS: 11 I Z N. M r rne r CITY: rt A r, STATE: ti/,4 ZIP CODE: 1 • PHONE NUMBER: G2 C3 -1(71r) STATE CONTRACTORS LICENSE NUMBER: 77) M S Tom*- 11-I- I M UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? NO (CIRCLE ONE) INTERIOR ALTERATION BY: L7ALz AL.( 1" LC."" --at 1 ADDRESS: PHONE NUMBER: CITY: cate, E STATE: k3f ZIP CODE: *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 IZt0 . " b''- TOTAL PERMIT FEE DUE 00 APPLICAN SIGNATURE: DATE: SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675