1996, 08-29 Permit App: 96007132 SewerSEWER CONNECTION PERMIT APPLICATION
*THIS APPLICATION FORM MUST BE FILLED OUT
SIGNED OR PERMIT WILL NOT BE ISSUED.
JOB ADDRESS: LA (Jr�
c)✓l LSIC�
CITY: -SPOKAN E Uric Ae,„te STATE: WA
OWNER NAME: ttA.taCE.G. DOUGLASS
SPOKANE STATE: WA
CITY:
L'r0-- 13'
Tp
r_ v .51 N
ACCURATELY D� I ENTIRETY AND
(IF KNOWN)
PARCEL NUMBER:
ZIP CODE:_�aC
ADDRESS: 815 E. ROSEWOOD AVE.
ZIP CODE: 99208-5599
PHONE NUMBER: (509) 483-6532
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES
EIRCLE ONE)
*IF PROPERTY OWNER INSTALLING
REQUIREMENTSMUST
BEFOREFIRST
PERMITCONTACT
ISSUEDTHE UTILITIES
DEPARTMENT FOR CONSTRUCTION
CONTRACTOR: CANNON EXCAVATING
CITY: SPOKANE STATE: WA
PHONE NUMBER: (509) 467-6522
STATE CONTRACTORS LICENSE NUMBER:
ADDRESS: P• O. BOX 28778
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES
INTERIOR ALTERATION BY:
PHONE NUMBER:_
ADDRESS:
CITY:
STATE: ZIP CODE:
ZIP CODE: 49208-8778
(CIRCLE ONE)
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION
• # OF BUILDINGS 1 X 50.00 = 50.00
X 35.00 =
TOTAL
INTERIOR PLUMBING ALTERATIONS: OF BNGS
PERMIT FEE DUE $
APPLICANT
SIGNATURE:
DATE: j 715-7;
SPOKANE COUNTY DEPARTMENT
�tOF BUILDINGS
WEST
60 (509) 456-3675
WEST 1026 BROADWAY AVENUE, SPOKANE,