1993, 04-05 Permit App: 93002136 SewerSEWER/PLUMBING PERIM APPLICATION FORM
INFORMATION WORKSHEET
/ F, Cf
PARCEL NUMBER:
JOB STREET ADDRESS: '7.1 7
CITY/STATE/ZIP: ,5/'4,(47.,' f
MAILING ADDRESS: S' c -
oc)7-
(Street)
CONTRACTOR: fi LW/1/4•4 5 ACTIVE
MAILING ADDRESS:
/41
(Street)
PHONE NUMBER:
(City/state) (Zip)
LICENSE NUMBER: A LI -AMY A (&P5
PHONE NUMBER: 9 as "8500
5lna S PnkANE WA 99alq
(City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE
X EACH
UNIT
=AMOUNT
X 50.00 =
,../7', —
X 35.00 =
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
_$
,,--
J
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675