1994, 06-16 Permit App: 94005505 Sewer CSoY
SEWER CONNECTION PERMIT APPLICATION FORM 1145 _ (r1Z
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND
SIGNED OR PERMIT WILL NOT BE ISSUED.
(IF
JOB ADDRESS : 924 S University Rd. PARCEL L NLONU)
UMBER:
CITY: Spokane, STATE: WA ZIP CODE: 99206
OWNER NAME: Dorothy M Morris ADDRESS: same
CITY: STATE: ZIP CODE:
PHONE NUMBER: 509-921-1994
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO
(CIRCLE
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE .UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: A I v\l Ct.1 S A -i v c,- ADDRESS : -P, . Be-N_ IL A5G,2
CITY: . yec-) �u STATE: WA ZIP CODE: gg2,0-!-
PHONE NUMBER: q2:2_ - g S-,r)
STATE CONTRACTORS LICENSE NUMBER: A LW Ali A -X' 1);_ j) 5
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE)
INTERIOR ALTERATION BY:
ADDRESS : PHONE NUMBER:
CITY: % STATE: ZIP CODE:
7
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION • # OF BUILDINGS 1 X 50. 00 = 50. 00
INTERIOR PLUMBING ALTERATIONS : # OF BUILDINGS X 35. 00 =
TOTAL PERMIT FEE DUE $ 50. 00
APPLICANT1L 6-13-94
SIGNATURE: DATE:
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675