1993, 10-28 Permit App: 93010401 Sewer 16321 . o4,05 c3. ot-toI
eAh_. .e.r tts SEWER/PLUMBING PERMIT APPLICATION FORM.443 /
L.6-13(., INFORMATION WORKSHEET 9. 5 -q31-/
JOB STREET ADDRESS: S /(77,--J'- c/ C , - ` /c
CITY/STATE/ZIP: 9.9 ?e. C2 PARCEL NUMBER:
MAILING ADDRESS: S. 3 3 iS /c y.-?-,t-) c/ ('; ( /t,
OWNER: /-h--) PHONE NUMBER:
Wm. I- / `'e r. 1 "S I'S' -'eel) (City/state) (Zip)
CONTRACTOR: ALtoP"1 S ACT eV E LICENSE NUMBER: ALLAIA1A+d°10(cP5
PHONE NUMBER: 9aa-8500
MAILING ADDRESS: s.0. --an.i, 1 y 15/0 a S PQkamE WA `t9a,lai '
(Street) (City/state) (Zip)
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00 = -5G
PLUMBING ALTERATIONS X 35.00 =
SUBTOTAL $
EQUALS: TOTAL S
P FEE DUE =$
SIGNATURE 7/ c
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675