1994, 07-20 Permit App: 94006708 Plumbing FixturesSEWER CONNECTION PERMIT
*THIS APPLICATION FORM MUST BE FILLED OUT
SIGNED OR PERMIT WILL NOT BE ISSUED.
JOB ADDRESS: S. `3
CITY: ;C"CJ %,i)lJc-
OWNER NAME: c,S7Xie
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taq' \ '?AJDUL)AJ
STATE : e -t-14
G�rA,uiW`fh4-n,..
-(t/ 7
APPLICATION FORM
ACCURATELY AND IN ITS ENTIRETY AND
(IF KNOWN)
PARCEL NUMBER:
ZIP CODE: C7gde)-4
ADDRESS:
CITY:
DDRESS:
CITY: STATE: ZIP CODE:
PHONE NUMBER: 9021 11-7/64-
PROPERTY
t / 4PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR(I!
CITY : ,Ser-A.am
ADDRESS : 1) IZ. I 4 c inec
STATE: Abk ZIP CODE: Ci'2/(k.
PHONE NUMBER: ciac5
STATE CONTRACTORS LICENSE NUMBER: 1-0 M S "T l- * /
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE)
INTERIOR ALTERATION BY: bU es -7- e34,i tip+ ii/v6-
ADDRESS: PHONE NUMBER: 9I / 64
CITY:
STATE:
ZIP CODE:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION '# OF
INTERIOR PLUMBING ALTERATIONS:# OF
APPLICANT
SIGNATURE•
Sliotvo2 1-oif,'T
BUILDINGS X 50.00 = 6-6 t-1--°-
BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $
DATE: �" /1-/-- '74
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675