HomeMy WebLinkAbout1994, 08-22 Permit App: 94008133 Sewer p
ti efr")
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 : 611 S University PARCEL NUMBER:
CITY: Spokane STATE: WA ZIP CODE: 99206
OWNER NAME: Jay Massey ADDRESS : 611 S University
CITY: Spokane STATE: WA ZIP CODE: 99206
PHONE NUMBER: 922-1910
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: Q[ 'S �'-O(15�fLt�-I'i0(1 ADDRESS : G I I E . 4444
CITY : ( 11\.e. STATE: Af,A ZIP CODE: G 920
PHONE NUMBER: G{2.'-4' -
STATE CONTRACTORS LICENSE NUMBER: FO 1 ,L S C.G q CI 1-I G 5
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE)
INTERIOR ALTERATION BY:
ADDRESS : PHONE NUMBER:
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 = ,6-0.6
INTERIOR PLUMBING ALTERATIONS : # OF BUILDINGS X 35 . 00 =
TOTAL PERMIT FEE DUE $ -02-e
APPLICANT
SIGNATURE: Ai _ _ DATE:
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675