HomeMy WebLinkAbout1992, 10-09 Permit App: 92008666 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM w /� �'� ��
INFORMATION WORKSHEET r
IZiAD ki ) t c
JOB STREET ADDRES - /7 it° ,,L,? 6e.,Lia , PARCEL N ER: Citi4"'
CITY/STATE/ZIP: 75..
- �l� °� A 9 't'
MAILING ADDF} SS: �'� �+� p,
OWNER: rK-� e4 PHONE NUMBER: 77c2 — 'c2`- ' r S 'i `� s-
(Street) (City/state) (Zip) L ill: 3
CONTRACTOR:C'•ouOgPOrlE ExcAvATioN LICENSE
NE NUMBER: lay 85�1 4.1 ,
PHO
MAILING ADDRESS: E. lb4Lb? UALLEYW,2i y {WE A -L WA- (Zip) o37 �CA
(Street) (City/state) ��G •
MO 5 yvowe 5 C*-
X EACH � ,n�
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00 = 0---- ��
PLUMBING ALTERATIONS X 35.00 =
SUBTOTAL $ �"� \O
'/‘
EQUALS: TOTAL C��J
V0
���
PEMIT FEE DUE =$ 6
— (3\3
•
SIGNATURE ta A,-,-e.ta'`e�'_k___'
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675