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1993, 03-29 Permit App: 93001887 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM ��� �4NFORMATION WORKSHEET ( .l / ' -T JOB STREET ADDRESS: /16 / // ?'' �,.,, Cn\'',C> CITY/STATE/ZIP: V'U e PARCEL NUMBER: `-' MAILING ADDRES / OWNER: (i4 /C, -2�6i—A PHONE NUMBER: �e_-: p:ZI~Z1-" (Street) (City/state) (Zip) CONTRACTOR: P LLOM 5 ACTIV E LICENSE NUMBER: A LtAmy A _to (012.5 PHONE NUMBER: 9aa-85oo MAILING ADDRESS: 0.0. --eiC),( Iy I5'ooZ PokAN+ Wa crjaici (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE X EACH UNIT =AMOUNT X50.00= s.—.7) `." X 35.0 AL $ ALS: TOTAL PEMIT FEE DUE _$ /� 5-Q __.. Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 9250 (29 QL