1993, 02-03 Permit App: 93000597 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS: C‘ 1a H (� � X111 fin"
CITY/STATE/ZIP: PARCEL NUMBER:
MAILING ADDRESS:
X13 sc-(1
OWNER:
CONTRACTOR:
PHONE NUMBER:
treet) (City/state)
t7 (\ t LICENSE NUMBER:
(Zip)
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