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1994, 07-25 Permit App: 94006962 SewerSEWER *THIS APPLICATION FORM SIGNED OR PERMIT WILL JOB ADDRESS: CONNECTION PERMIT APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND NOT BE ISSUED. (IF KNOWN) 6-'(--S-C) 2 PARCEL NUMBER: CITY: � STATE: /d?. ZIP CODE: OWNER NAME: /4 46941,/ �..C44.n4/ ADDRESS: CITY: STATE: ZIP CODE: PHONE NUMBER: 9,2d ?`lP PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES (NO) (CIRCLE ONE) *IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED. CONTRACTOR: 14 Co rLS--hc n G,f e CITY : L5100.g4f1Q , STATE : PHONE NUMBER: Ci 217 - S Q (o STATE CONTRACTORS LICENSE NUMBER: 1-i'S C (7 n) A- 4E. (2.-3 -k f ADDRESS: WA 1J8)1 ZIP CODE: g g 2,12/ UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES(:;;) (CIRCLE ONE) INTERIOR ALTERATION BY: ADDRESS: PHONE NUMBER: CITY: STATE: 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 = TOTAL PERMIT FEE DUE $ APPLICANT SIGNATURE: DATE: ):/c)7/l% SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675