1993, 10-28 Permit App: 93010400 Sewer q35 - q�3
SEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY
AND SIGNED OR PERMIT WILL NOT BE ISSUED .
�, ( IF KNOWN )
JOB ADDRESS: �/
_39:2.c -SS ---la �=Y�2 e.ziP4Pt.i PARCEL NUMBER:
CITY: .
STATE:' ZIP CODE:
OWNER NAME:
r-� 4,.e -,- ADDRESS: _ 2
CITY:
STATE: PHONE: 91,2 LSp�
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES cfrf,7
(CISCLE ONE )
*IF PROPERTY OWNER INSGSEWER , THEY MUST REQUIREMEN7S BEFOREIRST PERMIOTNISCISSUEDUTILITIES
DEPARTMENT FOR CONSTRUCTION
CONTRACTOR: ARMSTeD140 C31\15T U.CrION ADDRESS: ?o` BOx 142e7-
CITY: SPOKANE. vJPN- s TE-: gga�y PHONE: cae-0559
STATE CONTRACTORS LICENSE NUMBER . . : AVASTC7+`.5-9aN1
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES (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 =
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 = ,
TOTAL PERMIT FEE DUE $ _.,� '
APPLICANT i-/
SIGNATURE ./
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 ( 509 )456-3675