1993, 02-03 Permit App: 93000595 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS: . 1 a3 I a S4 a wcc,c)
CITY/STATE/ZIP: PARCEL NUMBER:
MAILING ADDRESS:
q3 -sus
93 S" I
OWNER: PHONE NUMBER:
(Street) (City/state) (Zip)
CONTRACTOR: `VAS Oco -r LICENSE NUMBER:
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