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1992, 06-15 Permit App: 92004364 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS: / 7 o , • S. CITY/STATE/ZIP: PARCEL NUMBER: MAILING ADDRESS: OWNER: PHONE NUMBER: (Street) (City/state) (Zip) CONTRACTOR: /• L . C , LICENSE NUMBER: PHONE NUMBER: 9 2 7 - (0 7 MAILING ADDRESS: lag"/ CA,00 ,/(/.cc 7�j¢. .�/ (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00 = , 0 PLUMBING ALTERATIONS X 35.00 = D r, �\ SUBTOTAL $ EQUALS: TOTAL � = PEMIT FEE DUE ��j. D ) � SIGNATURE C7\� Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675