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1992, 11-30 Permit App: 92010462 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM 9D, 3- / I 'Sr3 INFORMATION WORKSHEET CAD I D 4b 2 JOB STREET ADDRESS: E• 10.7 2.2- _ L' - '33-1 CITY/STATE/ZIP: 6 k,c.rt Q., IAA PARCEL NUMBER: MAILING ADDRESS: ?AA-Lk-- OWNER: ( ley S4.kcrt- PHONE NUMBER: q 28-/4 3 8 (Street) (City/state) (Zip) CONTRACTOR: H S C ,S-1-rucl-ion LICENSE NUMBER: HSCoDJ T. -11• 0-11(F PHONE NUMBER: 9tIA-89(DL{ MAILING ADDRESS: E• 11811 JALL tJJ 1/4f Pie. SPorAtoe, uTh. 997-Wo (Street) (City/state) (Zip) XEACH 0 L DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00 = S' k` a l D0 ' go PLUMBING ALTERATIONS X 35.00 = ` SUBTOTAL $ Q �� EQUALS: TOTALPIP e- PEMIT FEE DUE _$ Sc-' L1-1 I SIGNATURE1---)., t_ 46. Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675