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1992, 08-24 Permit App: 92006756 Sewer r c� SEWER/PLUMBING PERMIT APPLICATION FORM , j INFORMATION WORKSHEET 0\2, V ‘ JOB STREET ADDRESS: 30 / 7 C • aN/, U� Rs Tr CITY/STATE/ZIP: PARCEL NUMBER: OWNER: .Px37 CA-6 4's, PHONE NUMBER: MAILING ADDRESS: ff C (Street) (City/state) (Zip) CONTRACTOR: -'1 LICENSE NUMBER: PHONE NUMBER: C'_ _ .- 7 - (3 e ` )A / per Z: )��- _.S' A . `9�/4 MAILING ADDRESS: / �a /lr ,�� / �D /�� -L (Street) (City/state) (Zip) ,, , \4 X EACH DESCRIPTION UNIT =AMOUNT -',.} o SEWER CONNECTION X 50.00 = S-4 , OO `'" L--)-2, PLUMBING ALTERATIONS X 35.00 = SUBTOTAL $ �-\ 4a _$_ EQUALS: TOTAL �`'k PEMIT FEE DUE O. D d / \4Y) ) SIGNATURE,/ Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675