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1993, 03-12 Permit App: 93001433 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS: /08-? / S74 NUMBER: . CITY/STATE/ZIP: �0�a,rt PARCEL NU : rO ocz 9/13�� N MAILING ADDRESS: Sig e OWNER: BY/ "A 44- PHONE NUMBER: �� ( reet) (City/state) (Zip) CONTRACTOR: /'stn4�'4 LICENSE NUMBER: i-J/f'e.Sf!l' �3 W/Q PHpNJE NUMBER: 416 7 /9.3.2. MAILING ADDRESS: C.S-06.9 %� 4".reZZ/- ,2r .926 `'S .-SL'O� (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT (SEWER CONNECTION X 50.00= ..5e>' sY PLUMBING ALTERATIONS X 35.00= SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$ SC) We--_ SIGNATURE Spokane Coun Y ®epartment of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675