1993, 04-22 Permit App: 93002792 Plumbing Reversal 9, 3 _ Z-7�0 7%c�
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v SEWER CONNECTION PERMIT APPLICATION FORM C)1 .35- 2. 0�
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY
AND SIGNED OR PERMIT WILL NOT BE ISSUED .
( IF KNOWN )
JOB ADDRESS: LOc-{ S U,c iw,cftr PARCEL NUMBER:
CITY: S061c-cr`-e STATE: , 7 ZIP CODE:
OWNER NAME: P . H G ,x,s ADDRESS:
CITY: STATE: PHONE: gag`02 ,S
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES( YISCLE< SNE)
*IF PROPERTY OWNER INSTALLING SEWER , THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUEQ.
CONTRACTOR: 1-0-S ADDRESS: i181-2 E Oc,N e r 7
CITY: 6k:cs� STATE:_ PHONE: 9 ZU-UCsq
STATE CONTRACTORS LICENSE NUMBER . . : Lc -S- Can) xx 12:-MF
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES NO ( CIRCLE ONE )
INTERIOR ALTERATION WORK BY . . : I-4s
ADDRESS: PHONE:
CITY: STATE: ZIP CODE:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING , SHOP , GARAGE , ETC
THAT WILL BE CONNECTED TO THE SEWER .
SEWER CONNECTION # OF BUILDINGS X 50 .00 = SL.
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35 .00 = ?\15 TOTAL PERMIT FEE DUE $
APPLICANT
SIGNATURE7(4--
SPOKANE
COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 ( 509 )456-3675