1994, 03-28 Permit App: 94002487 SewerSEWER CONNECTION PERMIT
*THIS APPLICATION FORM MUST BE FILLED OUT
SIGNED OR PERMIT WILL NOT BE ISSUED.
JOB ADDRESS : S' 3R 07 ci U L
CITY : SpO STATE : LOA'
OWNER NAME : -T(C t _L & L-) A, T
CITY: (3 k sA -L STATE:
PHONE NUMBER: ,.5-.35--04.9?
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION?
APPLICATION FORM
ct4 —24V7
145-32.5
ACCURATELY AND IN ITS ENTIRETY AND
c,) la
(IF KNOWN)
PARCEL NUMBER:
ZIP CODE: qqf %'1
ADDRESS: 5-3907 12 i pc, e- Oc C`J
ZIP CODE: �'1 q9-- l 4
YES
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: 72a 6-I"D F-LGQICI-Lt13
CITY:nr'��1 2�r
PHONE NUMBER: Cf2. �7) - l r ! C
ADDRESS:
STATE: 44
STATE CONTRACTORS LICENSE NUMBER:
III2. /'J.
M Cur c
ZIP CODE: q02 -/c-
7?) M T 4-
l02/(-
7?)MSTC4- I U i. M
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE)
INTERIOR ALTERATION BY:
ADDRESS: PHONE NUMBER:
CITY:
STATE:
ZIP CODE:
*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 $
SO
APPLIC
SIGNATURE:
DATE: %- 2.-5' l
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675