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1992, 06-04 Permit App: 92004033 Plumbing Reversal
,_PLUMBING PffRMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS: 3 0 C7 ", ,2 (I N( 1/�2-5J7/ CITY/STATE/ZIP: PARCEL NUMBER: MAILING ADDRESS: OWNER: PHONE NUMBER: � (Street) (City/state) (Zip) - CONTRACTOR: l 4 .0. DNS/ . LICENSE NUMBER: PHONE NUMBER: - MAILING ADDRESS:/3r/6 6./474* qe, X '✓� / Zi . 99.,1 / 4 (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00 = PLUMBING ALTERATIONS X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$ SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675