HomeMy WebLinkAbout1992, 12-08 Permit App: 92010776 Plumbing Reversal SY
SEWER/PLUMBING PERMIT APPLICATION FORM l 2_ fc377
INFORMATION WORKSHEETCI
JOB STREET ADDRESS:
S t 2.GC (Jr)aueraL 2—I
9
CITY/STATE/ZIP: ;0 ke.r PARCEL NUMBER:
MAILING ADDRESS: SA LA.r
OWNER: L)ic{,w Let.cLAkr PHONE NUMBER: 24-Cs: a
(Street) (City/state) (Zip)
CONTRACTOR: H E S CONS7i2.3.,lcTroN LICENSE NUMBER: HSCONw4,IF 1231(F
PHONE NUMBER: q26-891,4
MAILING ADDRESS: E 11817 UA1.L EYG110 AVE BPO k NE WA 94000
(Street) (City/state) (Zip)
XEACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00=
PLUMBING ALTERATIONS X 35.00= 3S -
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE _$3C" —
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675