1993, 11-02 Permit App: 93010561 Sewer( OGJ L \
SEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS: 4027 S Ricdgevi ew Dr
CITY/STATE/ZIP: Spokane , WA PARCEL NUMBER:
MAILING ADDRESS: 4027 S Ridgeview Dr.
OWNER:J David Anderson
PHONE NUMBER: 922-1218
(Street) (City/state) (Zip)
CONTRACTOR: LUirk`15 AGT+V E LICENSE NUMBER: A I.WA/ A+f 40to495
PHONE NUMBER: 9aa-85oo
MAILING ADDRESS: . IU 1 5(o ' POkANE WA 49aNy
(Street)
(City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE
X EACH
UNIT
=AMOUNT
X 50.00 =
5-.Q0
X 35.00 =
SUBTOTAL
$
EQUALS: TOTAL
PPMIT FEE DUE
=$
50.00
Spokefie�ounty Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675