1994, 08-22 Permit App: 94008119 Plumbing Reversal04/04/1993 21:52 509-9284306
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RON SLOAN
SEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM MUST BE FILLED OUT
SIGNED OR PERMIT WILL NOT BE ISSUED.
JOB ADDRESS:
CITY: /` STATE:
OWNER NAME: - L.L1 h h' 1 a p'Y1
S
FAUL nl
gue
ACCURATELY AND IN ITS ENTIRETY AND
CITY:
STATE:
(IF KNOWN)
PARCEL NUMBER:
ZIP CODE: ”1-1c0
ADDRESS:
ZIP CODE:
PHONE NUMBER: Ci:1— 1 0
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION?
YES NO
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: A_ Aica.IS Ala4i " ADDRESS: -P, n. fr,AL 14 -15G.,2 -
CITY :
STATE: WA ZIP CODE: Qc12,14
PHONE NUMBER: q2.2. -
STATE CONTRACTORS LICENSE NUMBER:
UTILITIES INSTALLERS PERMIT NUMBER:
A LAAJ jargA *- 1(1)6., p5
INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE)
INTERIOR ALTERATION BY: '— A iSoV 1--
ADDRESS:
CITY:
PHONE NUMBER:
STATE: CODE:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION •11 OF BUILDINGS X 50.00 =
INTERIOR PLUMBING ALTERATIONS:# OF BUILDINGS— X 35.00 =
APPLICANT
SIGNATURE:
TOTAL PERMIT FEE DUE $ C
aou
SPOKANE COUNTY DEPT., OF BUILDINGS
WEST 1026 BROADWAY AVENUL,
SPOKANE, wa 99Z60
Co.A4-41
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