1994, 10-13 Permit App: 94010160 Plumbing Reversal ( f02-0[4- 0A-5- 1141 c114- 131‘,
-0411\ SEWER CONNECTION---PERMIT APPLICATION FORM 41'1 • 101
Z
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND
SIGNED OR PERMIT WILL NOT BE ISSUED.
(IF KNOWN)
JOB ADDRESSS So. 1615 Wardson ee PARCEL NUMBER:
CITY: 5/27e.)04.41-71/6-- STATE: kir! ZIP C*DE:
OWNER NAME: Paul Barthelmes — ADDRESS:
CITY: STATE: ZIP CODE:
PHONE NUMBER:
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: 4Ivsic 4c_4-;v e— ADDRESS: I0.15(,)2_
CITY: ,4Q0.1CIa/1e STATE: WA ZIP CODE: gg2,t 1-4-
PHONE NUMBER: c122.- g c n)
STATE CONTRACTORS LICENSE NUMBER: A LVJ AY A 4- 10(n PS
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? ES NO (CIRCLE ONE)
INTERIOR ALTERATION BY:
ADDRESS : PHONE NUMBER:
CITY: S 'u Ae/live-. STATE: VV ZIP CODE: 9t / L/
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION . # OF BUILDINGS 1 X 50. 00 = 50 . 00
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS 1 X 35. 00 = 35 = 00
TOTAL PERMIT FEE DUE $ 85: 00
APPLICANT 10-12-94
SIGNATURE: AN DATE:
SPOKANE COUNTY. DEPT., OF BUILDINGS
WEST 1026 BROADWAY.'AVENUL
SPOKANE, A -77 99260 C // ' Z_-