1993, 08-03 Permit App: 93006578 Sewer -
SEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY
AND SIGNED OR PERMIT WILL NOT BE ISSUED .
( IF KNOWN )
JOB ADDRESS: ,9 672 7 -� PARCEL NUMBER: O 5 Z//3 • go01
STATE: /74.1,7, ZIP CODE:
OWNER NAME:r/ 4 ADDRESS:
CITY:
STATE: PHONE: 9;? 1.?
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO
(CISCLE ONE)
*IF PROPERTY OWNER
CONSTRUCTIONINSTALLING
REQUIREMENTS BEFOREFIRST
PERMITCONTACT
UTILITIES
DEPARTMENT FOR ISSUED
CONTRACTOR: PRAMS I2DNO.ONSrP.U.CnON ADDRESS: O.O. Bak 14282..
CITY: SPOKANE. Pr S�
WTATC: j I'4 PHONE: gl'0559
STATE CONTRACTORS LICENSE NUMBER . . : AeMSTC7+`19a N1
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES Wig) (CIRCLE ONE )
INTERIOR ALTERATION WORK BY . . :
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 =
5-0
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $ _, 29
APPLICANT / /40
i„
SIGNATOR --
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 ( 509)456-3675