HomeMy WebLinkAbout1992, 12-08 Permit App: 92010777 Plumbing Reversal SEWER/PLUMBING PERMIT APPLICATION FORM 9Z
INFORMATION IWORKSHEET
JOB STREET ADDRESS: S. 1 12"C L.Jtnio.v3t 7 \
CITY/STATE/ZIP: Seak.[r`Q utsA- P EL NUMBER:
MAILING ADDRESS: SR►-&C
OWNER: 1f,e ris PHONE NUMBER: g ZG-Li 163
(Street) (City/state) (Zip)
CONTRACTOR: N E S coNS72UC rioki LICENSE NUMBER: HSCbt4 14,1c 12.3k.�
PHONE NUMBER: '126-89(04
MAILING ADDRESS: E /18/7 VAU EVIdbY AVE 3Po kmNe WA qq,goo
(Street) (City/state) (Zip)
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00 =
PLUMBING ALTERATIONS X 35.00= -),S —
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE =$ 3 S --
SIGNATURE ► .
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675