1992, 11-30 Permit App: 92010456 Sewer SEWER/PLUMBING I?ERMIT.APP.,LICATION FORM ,
INFORMATION WORKSHEET -�
JOB STREET ADDRESS: 5 . 1-3.21 cAc-Iu r s' c a 5- i 'l 7
CITY/STATE/ZIP: SolAI✓e.x.., u..114 PARCEL NUMBER: 9 _ IL,cjcDc,_,
MAILING ADDRESS: SAKt
OWNER: 1e c-F (-6•\-, PHONE NUMBER: 9`tt-t-`l 7? 30a1
(Street) (City/state) (Zip)
CONTRACTOR: H E S aONS712UCTIOK( LICENSE NUMBER: HSCON'41',K 1a3KF
PHONE NUMBER: '926-89404 F
MAILING ADDRESS: 1t8)T UALL V4J / AVE SPok+rNe WW 99=0
(Street) (City/state) (Zip)
X EACH DLP
DESCRIPTION UNIT =AMOUNT
1.-i- f'
SEWER CONNECTION X 50.00= / S� i�,�- /�� .
PLUMBING ALTERATIONS X 35.00=
SUBTOTAL $
EQUALS: TOTAL 1(� � a� 3'�O-
PEMIT FEE DUE =$ So ' N.
SIGNATURE 7C2:"--4~ "'
K -Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675