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1993, 02-03 Permit App: 93000596 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS: fr /5 sou+ c 6 CITY/STATE/ZIP: PARCEL NUMBER: W3DC.° OWNER: PHONE NUMBER: MAILING ADDRESS: 351- \‘C\ 5 (Seet) (City/state) (ZG? �/ - CONTRACTOR: Ol l'Atr f� LICENSE NUMBER: �S tf�C` KS PHONE NUMBER: MAILING ADDRESS: (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT =AMOUNT X 50.00 = X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$ SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675