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1992, 10-30 Permit App: 92009602 Sewer
SEWER/PLUMB.„ 3 PERMIT APPLICATION F . .PAM INFORMATION WORKSHEET r JOB STREET ADDRESS: - 0 �.1 , — CITY/STATE/ZIP:4-54'ir44,e . t alis PARCEL NUMBER: MAILING ADDRESS: OWNER,oVAOL C.e-4-s4' -r/ PHONE NUMBER: 9 5/ 3 5 _ (Street) (City/state) (Zip) CONTRACTOR [3#<4 Ge/s-7---- LICENSE PONE NUMBER: to A',�/WI� 8‹./ -/c S MAILING ADDRESS: 92/5 z 4774 .530cr/r�y` '�` 5-4 9 9 2 4.., - (Street) �(Street) (City/state) (Zip) X EACH D�� DESCRIPTION UNIT =AMOUNT t0 t SEWER CONNECTION X 50.00= Vs` PLUMBING ALTERATIONS X 35.00= Olf I SUBTOTAL $ to\,\ EQUALS: TOTALPEMIT FEE DUE =$ FC SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675