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1992, 10-27 Permit App: 92009391 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM ,1��5 INFORMATION WORKSHEET c\a JOB STREET ADDRESS: ' ( E_3(. ; V i`'Yi-' '3 a CITY/STATE/ZIP: t)� .c-i,. u m i,ARCEL NUMBER: MAILING ADDRESS: "54%uE OWNER: `rs `l'f-n I4<Nr— PHONE NUMBER: 72L1 -Coo 2C (Street) (City/state) (Zip) CONTRACTOR: H E S CANSTRUCT IOt.1 LICENSE NUMBER: l-HSCON 1231(F. PHONE NUMBER: q26—89/04 MAILING ADDRESS: E 11817 thAt.L.E/4P/ AVE 9Po kPNE WA 99000 (Street) \ (City/state) (Zip) X EACH e�� s -� DESCRIPTION UNIT =AMOUNT \/ (9(Q PLUMBING ALTERATIONS X 35.00 = �� `�. � , ' °Ic A SUBTOTAL $ & , ` EQUALS: TOTAL 0 ec PEMIT FEE DUE _$ cc) SIGNATURE (.-�^ " Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675