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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