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1993, 11-05 Permit App: 93010751 Plumbing Reversalti l% .i d1.h�0 SEWER CONNECTION PERMTT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENT ETlY AND SIGNED OR PERMIT WILL NOT BE ISSUED. 83,1 (;75-0 pis g74, (IF KNOWN) JOB ADDRESS: ��-� �� uflJ 1 - PARCEL NUMBER: CITY: � �.� � Q STATE: % /©j - Z IP CODE : 99 ? OWNER NAME: r.L i,>'r,> ADDRESS: CITY: STATE: PHONE: 9-2 PROPERTY 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 ISSUELQ. CONTRACTOR: 1445 CO ft5-}"f U CA -ion ADDRESS: I 3 11 GT. *L..► l,e. CITY: :5 O (c1I1e_ STATE: V./A �a2 PHONE: SOG • q2(, • (3cu 4 STATE CONTRACTORS LICENSE NUMBER..: 1 S LON] 44* 123 K UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES NO i (CIRCLE ONE) INTERIOR ALTERATION WORK BY..:Y7-/--- �e`1ti z. ADDRESS: PHONE: CITY: STATE: ZIP CODE: *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION - 4 OF BUILDINGS / X 50.00 = INTERIOR PLUMBING ALTERATIONS: 4 OF BUILDINGS / X 35.00 = TOTAL PERMIT FEE DUE $ APPLICANT SIGNATURE SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675 a