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1992, 10-14 Permit App: 92008636 Sewer
1 V)�� SEWER/PLUMBING PERMIT APPLICATION FORMI INFORMATIOI NWOP. SH 0\'; JOB STREET ADDRESS: CITY/STATE/ZIP: `. ti 7 ( PARCEL NUMBER: MAILING ADDR SS: I PHONE NUMBER: OWNER: (Street) (City/state) (Zip) LICENSE NUMBER: CONTRACTOR: S AGTIV E — 9aa-w^� PHONE NUMBER: WA _qac 4 MMAILING ADDRESS: . • .-8. I y 151Da P.kAN (Street) (City/state) (Zip) CS41 DESCRIPTION ISM=AMOUNT -' " X 50.00= ``'� �' SEWER CONNECTIONX 35.00= D� PLUMBING ALTERATIONS SUBTOTAL \ O\� �_ EQUALS: TOTAL `reS�t �� PEMIT FEE DUE v ct0� 8 L. SIGNATURE _.Aii' Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675