1994, 01-06 Permit App: 94000150 Sewer 08123/1992 23:40 509-9284306 RON SLOAN q PAGE 01
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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