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1992, 10-09 Permit App: 92008646 , 92008647 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM Rzc- t oc) I , INFORMATION WORKS+EET Gk' � v �' ^ JOB STREET ADDRESS: ,1 7! 0 S (2(C)-- CITY/STATE/ZIP: 2( )-CITY/STATE/ZIP: PARCEL NUMBER: 1lT �� MAILING ADDRE S: OWNER: PHONE NUMBER: 9,27—'/f< j /- (Street) (City/state) (Zip) CONTRACTOR: l , l C_ - LICENSE NUMBER: PHONE NUMBER: o2 , MAILING ADDRESS: /37/ !_2-71-4 T 'c),&Q-/L.E� / - 997- ' (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00= ,5 U (De) PLUMBING ALTERATIONS X 35.00= '3<,'. ©u SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE _$ `> CX_) SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675