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1992, 08-04 Permit App: 92005807 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM 9-Z 5 --1(e i INFORMATION WORKSHEET Q Z-S5 STREET01 ADDRESS: �J/ On, i �, r ? 1, `JOB ,�' CITY/STATE/ZIP: ��r'��� = PARCEL NUMBER: 66 MAILING ADDRESS: >n,-1PHONE NUMBER: 414 OWNER: (Street) (City/state) (Zip) CONTRACTOR: AJX_r LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/state) (Zip) X EACH a04' 'a\J DESCRIPTION UNIT =AMOUNT Pt.CONNECTION X 50.00 = U�\� �(5� _ 1 0 (PLUMBING ALTERATIONS X 35.00= \� \. I SUBTOTAL $ 2 I E*UACs: TOTAL 'EMIT FEE DUE =$ .. SIGNATOR �" .-* Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675