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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