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1993, 05-17 Permit App: 93003590 Sewer .Ql,U © 4-c L- V7 6-Z- CV-3- 359 31 o o O�c a�Q S SEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILIEDUOUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT ( IF KNOWN) 1;14 PARCEL NUMBER: JOB ADDRESS= 0)40- 41-11—air OWNER NAME= STATE: ZIP CODE CITY= &ICLV ADDRESS: 14AZ,20 CITY: STATE= ---141147-44114-Of PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO (CIRCLE ONE) *IF PROPERTY OWNER INSTALLING SEWER , THEY MUST FIERST COONTACTSTHEDHE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS CONTRACTOR: A'L-WP015 AC-TWE ADDRESS: ^?o, gox 11415ba CITY: SPoloc1\lE ST : qqa� PHONE: Cl@D-a wo STATE CONTRACTORS LICENSE NUMBER . : Po-w A :at 10(D P5 UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES ea) (CIRCLE ONE) INTERIOR ALTERATION WORK BY . . : ^� PHONE: ' ADDRESS:_ CITY: STATE: ZIP CODE: —w. *ONE PERMIT REQUIRED EACH BUILDING , SHOP , GARAGE, ETC THAT WILL BE CONNECTED TO SEWER CONNECTION ' # OF BUILDINGS X 50.00 = X 35.00 = INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS TOTAL PERMIT FEE DUE $ APPLICANT SIGNATURE AIA SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 ( 509 )456-3675