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1993, 10-15 Permit App: 93009378 Sewer ' APPLICATION FORM 60r 9-�7g SEWER�PLUMBING PERMIT � INFORMATION WORKSHEET 613,5 - 2_101, S 2616 Vercler JOB STREET ADDRESS: CITY/STATE/ZIP:__p ane r X77 9 29 6 PARCEL NUMBER: MAILING ADDRESS: . is- OWNER:Agnes Erickson PHONE NUMBER: (Street) (City/state) (Zip) LICENSE NUMBER CONTRALTO FHONE NUMBER = ,. MAILING ADD' _• ' �� (Street) (City/state) (Zip) X EACH UNIT =AMOUNT DESCRIPTION50. 00 SEWER CONNECTION X 50.00 = PLUMBING ALTERATIONS X 35.00 = 11111111111.1" SUBTOTAL EQUALS: TOTAL 50 . 00 PEMIT FEE DUE =$ / , / SIGNATURE / i - Spokane County Department of Buildings , (------- West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675