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1993, 11-17 Permit App: 93011215 SewerSEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN;; AND SIGNED OR PERMIT WILL NOT BE ISSUED. n (IF KNOWN) JOB ADDRESS: 5 Lh4. Jlfn PARCEL NUMBEk CITY: 14:446 STATE: /6g ZIPCODE: OWNER NAME: k 1-k(i?-1 TT ADDRESS: 4Al ►el l7 CITY: STATE: PHONE: PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? *IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT THE DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSVF CONTRACTOR:10WW /4f` ADDRESS: CITY: -©Y04. STATE: JA . PHONE: STATE CONTRACTORS LICENSE NUMBER..: YVi UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES INTERIOR ALTERATION WORK BY..: ADDRESS: CITY: ==s=====,` *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION # OF BUILDINGS INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 APPLI SIGNAT TOTAL PERMIT FEE DUE SPOKANE COU DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVE E SPOKANE , WA 99260 (509)456-3675'