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1994, 01-06 Permit App: 94000150 Sewer 08123/1992 23:40 509-9284306 RON SLOAN q PAGE 01 _ , I�'ASO SEWER/PLUMBING PERMIT APPLICATION FORM ��5 , �3 INFORMATION WORKSHEET JOB STREET ADDRESS: CITY/STATE/ZIP: 99 PARCEL NUMB 3.:i 7--i G MAILING ADDRESS:--,-----------..-------- DDRESS: PHONE NUMBER: OWNER: (Street) (City/state) RIP) CONTRACTOR:A.1111NY AGT'V E LICENSE NUMBER: ALWA`f A•' A.OIo9°4 PHONE NUMBER: 9aa-WOO ________ 4 �NI5(oa gP a wA i MAILING ADDRESS: �•C.-86( (ZAP) (Street) (City/state) X EACH DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00.. Ira r PLUMBING ALTERATIONS X 35.001. SUBTOTAL 5 EQUALS: TOTAL PEMIT FEE DUE 4 5 o — SIGNATOR Spokane County Department of Buildings West 1303 Broadway Avenue Spokane,WA 99260(509)456-3675