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1992, 09-22 Permit App: 92007931 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM (� �' K INFORMATIQ.� WORKSHEET "I�S JOB STREET ADDRESS: v 00. ISM c ( rl CITY/STATE/ZIP: } PARCEL NUMBER: ( � i AJ/2- ""'i 2 07 OWNER: / IZ Rs'g'G,CCti 4 PHONE NUMBER: MAILING ADDRESS: 230 / .Y 1: crud A-4.e -& 14,)� I 1 c 7 (Street) (City/state) (Zip) q , I C.-Ia./1,4,LICENSE NUMBER: 1L e c.c.64IC 'f" f.4: 3 j� 3 PHONE NUMBER: Q 2 A"; 0161' MAILING ADDRESS: SST e)2- 1-7:,, 2k--fi-ie 992 fr7 (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