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1992, 06-25 Permit App: 92004708 Sewer
X51 L23-c26a1 Q�a.60,0 ``4 SEWER/PLUMBING PERMIT APPLICATION FORM '0rFf 4. -(1 INFORMATION WORKSHEET , 15 JOB STREET ADDRESS: /0 4/ 57/ CR- 410 CITY/STATE/ZIP: Sp 42 �l>‘ PARCEL NUMBER: e)- F/ MAILING ADDRESS: ,A--4' OWNER:Net:Wee J/ ,4 /fee" PHONE NUMBER: ' .Q- 7‘ CONTRACTOR: gc L (Street) MAILING ADDRESS: fr/91(-( (Zip) LICENSE NUMBER: [� PHONE NUMBER: (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE X EACH UNIT =AMOUNT X 50.00 = X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE _$ Spokane ,,ir;,Ty Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675