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1993, 11-17 Permit App: 93011219 Plumbing Reversalq531Z 1c),\A_ LIZz`i i SEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN AND SIGNED OR PERMIT WILL NOT BE ISSUED. JOB ADDRESS: 5-;—-12-1&,..o...4...14,0,1 �7Or CITY: STATE: vJA50 (IF KNOWN). PARCEL NUMBER: ZIP CODE: OWNER NAME: ,ZY./) aCLC'tEXVI ADDRESS: '7 ,(N -e- CITY: STATE: PHONE: PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? .' YES ('C I RCk *IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT THE U DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS'''ISSUEt CONTRACTOR: To 51 -f ADDRESS: CITY: '' STATE: CIA STATE CONTRACTORS LICENSE NUMBER..: UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES� NO (CIRCLE ONE) INTERIOR ALTERATION WORK BY..: ADDRESS: /`( / / / Z j )'lf 1Vi e(Z- PHONE: STATE:AjjH ZIP CODE: *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE,, THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION # OF BUILDINGS X 50.00 = INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS l X 35.00 = APPLIC SIGNATURE TOTAL PERMIT FEE DUE kfai PLLu.,►M,6, u SPOKANE CO TY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675