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1993, 04-20 Permit App: 93002701 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM q 3-- @ 70 I s INFORMATION WORKSHEET JOB STREET ADDRESS: () i b _ —- —— isg".."- -,--....4L- -. ` LAP cq ,5-.0 .Sk) CITY/STATE/ZIP: o'f'=t Z-D •ARCEL NUMBER: ---1Y1MAILING AQD�tESS: OWNER: V4---1/1J `^"`' PHONE NUMBER: G( G.ZO Ce 4 ( ZJ T €1 (Street) (City/state) (Zip) CONTRACTOR: A LWPs'i 5 AGTiV E LICENSE PHONE NUMBER: A ilk ac?'85 .106,42.5 • MAILING ADDRESS: ly I56 P©kAm WA 99a1q �•�� --de-w, (Street) (City/state) (Zip) IX EACH I I S- \(° v(A& DESCRIPTION UNIT =AMOUNT a SEWER CONNECTION X 50.00 = ��` C9 (PLUMBING ALTERATIONS X 35.00 = $ �5 SUBTOTAL �� `\ EQUALS: TOTAL - ‹J ff A 1 jo 0 r PEMIT FEE DUE _$ .5-O �� Z c Y SIGNATURE/ 1 7 / Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675