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1993, 07-21 Permit App: 93005898 Sewer\\I , tlaKs-rvio erora.m. c135 ".5t) g3 -589S' SEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT BE ISSUED. � ( IF KNOWN) JOB ADDRESS: o ��-S C/ �'� 'e PARCEL NUMBER: STATE:‹ ZIP CODE: CITY: OWNER NAME: ADDRESS: CITY: STATE: PHONE: 4;Y,21).- 3'72' PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES 4(7 (YISCLE ONE) *IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED. CONTRACTOR: I RdYiST20N& cMN5TP_LtalON ADDRESS: ?.o. Box /4282-. CITY: SPOKRNE. J Pr STATE: gqaiti PHONE: 928' 0559 STATE CONTRACTORS LICENSE NUMBER..: AeMSTC*19aN1 UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES (9 (CIRCLE ONE) INTERIOR ALTERATION WORK BY..: ADDRESS: PHONE: 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 = 4-4;5. INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 = TOTAL PERMIT FEE DUE $ APPLICANT SIGNATUR SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675