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1994, 10-21 Permit App: 94010487 Sewer - - ( 1- t 014 SEWER CONNECTION PERMIT APPLICATION FORM ckL4 ,l- *THISFILLED OUT ACCURATELY AND IN ITS ENTIRETY APPLICATION FORM MUST BE AND SIGNED OR PERMIT WILL NOT BE ISSUED. (IF KNOWN) JOB ADDRESS : S /4,27-- PARCEL NUMBER: CITY: 5/U2// 7V6 STATE: 1'V4 ZIP CODE: OWNER NAME: 6- `(-2 4 /`&`cr r/ ADDRESS: CITY: _;,/ G '-t-P STATE: Z-c-/A- ZIP CODE: PHONE NUMBER: y . 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: A lvJalS 4[.14 i ADDRESS: -P.(). fr)Y I1-I-L56,2, CITY: ,4,�n4C /1e_. STATE: WA ZIP CODE: cp2ALp PHONE NUMBER: '5I Q2 — 4 rO • STATE CONTRACTORS LICENSE NUMBER: AO-V /k-'44% 106, Pg UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE) INTERIOR ALTERATION BY: ADDRESS: � PHONE NUMBER: CITY: �/ 7 C) le I✓e- STATE: V/ ' ZIP CODE: e) C../e / C"/ *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION . # OF BUILDINGS X 50. 00 = -c---c/ INTERIOR PLUMBING ALTERATI,ONS: # OF BUILDINGS X 35. 00 = 3S" TOTAL PERMIT FEE DUE $ Sj- APPLICANT • ' S I GNATURE: /7 ..• DATE: /6//7 /1 SPOKANE COUNTY DEPT.. OF BUILDINGS WEST 102.6 BROADWAY'AVENUE - �� SPOKANE, 99260. A 7T-: c A