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1993, 02-05 Permit App: 93000625 Plumbing Reversal SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET l/25 E.-16-,i � c ` JOB STREET ADDRESS: -LE-i___:1.— PARCEL NUMBER: CITY/STATE/ZIP:� MAILING ADDRESS: PHONE NUMBER: OWNER: (Street) (City/state) (Zip) A \JE LICENSE NUMBER: A I-WAY A'�`-1(�(s'P5 CONTRACTOR: '�' '��y S GTi '�-�-�KQ- PHONE NUMBER: - —o.�. o MAILING ADDRESS:____ . • P4I Soa P•kAnl WA -9a.1 (Street) (Cityistate) (Zip) DESCRIPTION NM=AMOUNT 1111110111111111111 SEWER CONNECTION X 50.00 = PLUMBING ALTERATIONS .j1111111111111111 B00 TOTAL 131.011111111111 ■ EQUALS: TOTAL PEMIT FEE DUE , 111111111b SIGNATUR....s_ Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675