HomeMy WebLinkAbout1993, 02-10 Permit App: 93000758 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS:
CITY/STATE/ZIP:
MAILING ADDRESS:
OWNER:rf.6 Choc V er, kb
(Street)
CONTRACTOR: 0.1,10 E XC
PARCEL NUMBER: i/o
MAILING ADDRESS:
PHONE NUMBER:
(City/state) (Zip)
LICENSE NUMBER: 6« f) o_?�
PHONE NUMBER:
ity/state) (Zip)
( treet)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE...
X EACH
UNIT
=AMOUNT
X 50.00 =
X 35.00 =
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
=$
pokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675