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1993, 03-10 Permit App: 93001379 Sewer
4 - r SEWER/PLUMBING PERMIT APPLICATION FORM `�� INFORMATION WORKSHEET 30SS' -7 JOB STREET ADDRESS: l-- D ---- A� _____ ___ el 3 3 '1 CITY/STATE/ZIP:44�- PARCEL NUMBER: __.- ------------ ------------- MAILING ADDRESS:___--- (Street) (City/state) (Zip) CONTRACTOR a LICENSE NUMBER: "ThryISTrerk____Ntrin PHONE NUMBER: q)t C7 MAILING ADDRESS:a, :---? 'tX M tS4 41-. 111 .44.1,15e, -61-4-}:-LY------ - (Street) (City/state) (Zip) - - -- - \ IXEACH j 5 DESCRIPTION NIT i LU =AMOUNT iSEWER CONNECTION IX 50.00 = ..PLUMBING ALTERATIONS X 35.00 = SUBTOTAL EQUALS: TOTAL 00 �PEMIT FEE DUE =$ '�'-- lVot � �' �� s-131 SIGNATURE 4k) 59Spokane County Department of Buildings t�'vv I West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675