HomeMy WebLinkAbout1993, 07-30 Permit App: 93006434 Sewer vu,_;\ -ac-1
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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 . r,
( IF
JOB ADDRESS: 23O( JI "Al r'eS S PARCELI<NUUMBER: LT Ci{�' I 2
CITY: J/4"ece47-c STATE: 0.t , ZIP CODE:
OWNER NAME: gilg�t ADDRESS: .,-23° Y
CITY: St-2, k STATE: PHONE: 9a4 -Dc 7L
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES (07
( CIRCLE ONE )
*IF PROPERTY OWNER INSTALLING SEWER , THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUEa.
CONTRACTOR: �� it-a.5/4- 4,ti ADDRESS: .6o X .3V 7
CITY: °1 ea h,4 STATE: Li PHONE: ,'2-V-°7J2°
STATE CONTRACTORS LICENSE NUMBER . . :
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES NO ( CIRCLE ONE )
INTERIOR ALTERATION WORK BY . . :
ADDRESS: PHONE:
CITY: STATE: ZIP CODE:
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*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING , SHOP , GARAGE , ETC
THAT WILL BE CONNECTED TO THE SEWER .
SEWER CONNECTION # OF BUILDINGS X 50 .00 =
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35 .00 =
TOTAL PERMIT FEE DUE $
APPLICANT (iES--J(p
SIGNATURE
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 ( 509 )456-3675