1993, 10-15 Permit App: 93009889 Plumbing ReversalPb.alefoso, zn
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SEWER CONNECTION PERMIT APPLICATION FORM
q3s T8
'? 3,5 -5173
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY
AND SIGNED OR PERMIT WILL NOT BE ISSUED.
JOB ADDRESS: 3 2- 3
CITY:
OWNER NAME:
(IF KNOWN)
PARCEL NUMBER:
STATE:'z;>- ZIP CODE:
ADDRESS:
CITY: STATE: PHONE:
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 ISSUED.
CONTRACTOR : ARIYIST2DN& OoN55_UCiioN ADDRESS : ?.O . Box it -1 2$ 2-
CITY: SPOKANE 1)0 P-- STATE: 1 t41 PHONE: gz8-0559
STATE CONTRACTORS LICENSE NUMBER ..: AeMSTC 1 i N1.
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? c-gNO (CIRCLE ONE)
INTERIOR ALTERATION WORK BY..:
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 # OF BUILDINGS / X 50.00 = `5W 9R2
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 = ?S Wq
TOTAL PERMIT FEE DUE $
APPLICANT
SIGNATUR
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675