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1992, 07-15 Permit App: 92005332 Plumbing Reversal
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRES,S�;, � 3 /6-6 CITY/STATE/ZIP: J2-k) CSG' PARCEL NUMBER: OWNER: L' ��-� �'�;—� PHONE NUMBER: (77 :j y6-6 9 MAILING ADDRESS: ✓ : _ '` i L Lam, 1 LOjc__ (Street) (City/state) (Zip) 9*026 6 CONTRACTOR:Cot-teeH#.sme EXc+mATioe LICENSE NUMBER: COU ec.c X181gel PHONE NUMBER: q x4.5485 MAILING ADDRESS: E . /4,yba UA-U.EyWAy AVE YEeADALE- WA c0037 (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00 = PLUMBING ALTERATIONS X 35.00 = SUBTOTAL $ EQUALS: TOTAL _ PEMIT FEE DUE =$ -- SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675