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1993, 03-23 Permit App: 93001717 Sewer SEWER/PLUMBING P RMIT APPLICATION FORM 9 -_ 1 1 1 7 INFORMATION WORKSHEET JOB STREET ADDRESS: S - oC 3 ; L/ �i//?/v 2v si•-�` Ck- Sr CITY/STATE/ZIP: L)a PARCEL NUMBER: OWNER:7-ex A�-1 X u,e/404 PHONE NUMBER: 0-60 .,,,q3 F' G 6 / MAILING ADDRESS: L i�✓/- 172,9 6 /? / le-7 Head: 9 cr(Jo2 / (Street) (City/state) (Zip) CONTRACTOR: ..So/lie LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: S.si-e (Street) (City/state) (Zip) nAu X EACH V-c'- G- C \--2— DESCRIPTION UNIT =AMOUNT �\ SEWER CONNECTION X 50.00= \\'' G\\ L�J PLUMBING ALTERATIONS X 35.00= ' e- .� , SUBTOTAL $ - V�` EQUALS: TOTAL LVeS -- PEMIT FEE DUE =$ �J0c67° cN\�L-' ',) SIGNATURE 4 is _ 4` Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675