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1994, 08-11 Permit App: 94007718 Sewer61)Lte,Awdei ct4--771g SEWER CONNECTION PERMIT APPLICATION FORM `�("i1'S- gj *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT BE ISSUED. JOB ADDRESS: 5 c'Z p(IF KNOWN) - : c v N e PARCEL NUMBER: CITY: STATE: '--)`i OWNER NAME: �� k4-('\ ZIP CODE: �9zo6 ADDRESS: ifY0 S_ CITY• c'U�c(aif' STATE: ZIP CODE: 9?-Ziw PHONE NUMBER: '?-2-"5---"? 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: ''"' j e V s ADDRESS: CITY: SFak� PHONE NUMBER: STATE CONTRACTORS LICENSE NUMBER: UTILITIES INSTALLERS PERMIT NUMBER:, INTERIOR PLUMBING ALTERATIONS? INTERIOR ALTERATION BY: ADDRESS: CITY: STATE : ZIP CODE: `(92106 (CIRCLE ONE) STATE: PHONE NUMBER: 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: gbo/9/ SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675