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1994, 01-20 Permit App: 94000487 Sewer614 -1-1-g q c +5 '5LJ SEWER CONNECTION PERMIT APPLICATION FORM HIS APPLICATION FORM MUST BE FILLED DOT ACCURATELY AND IN ITS ENTIRETY kND SIGNED OR PERMIT WILL NOT BE ISSUED. TOB ADDRESS : -- �ITY: 1)0 (IF KNOWN ) t , PARCEL NUMBER: STATE: ZIP CODE: OWNER NAME CITY: PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? t 4, ADDRESS: STATE= ��1 PHONE: YES ... NO (CIRCLE ONE) cIF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRSTE COONTACTSTHE. UTILITIES DEPARTMENT CONSTRUC ON REQUIREMENTS CONTRACTOCL6t,( 1( t7/ADDRESS: CITY: STATE CONTRACTORS LICENSE NUMBER..: UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE) STATE: PHONE: INTERIOR ALTERATION WORK BY..: ADDRESS: PHONE= CITY: STATE: ZIP CODE: *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC THAT WILL BE CONNECTED TO THE SEWER. to SEWER CONNECTION # OF BUILDINGS X 50.00 = INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 = TOTAL PERMIT FEE DUE $ / APPLICANT SIGNATURE , 16- SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 (509)456-3675