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1993, 12-06 Permit App: 93011661 Sewer 1-15, 14, 0110 q3 -1447 bio 6' SEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT BE ISSUED . ( IF KNOWN ) JOB ADDRESS: Ltb t 3 S . S 4 .R PARCEL NUMBER: CITY P© R(J F STATE: LOA .. ZIP CODE: 1 . OWNER NAME: Det __ U1 ADDRESS: 1 O S S ' S C k f1 t-E P.,CITY: p'p (<A N STATE: tA•N\ . PHONE:qa.4 c�C0 .�O � PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES (CISCLE ONO ;) *IF PROPERTY OWNER INSTALNGSEWER, THEY MUST REQUIREMENTS BEFOREIRST PERMIOTNISCISSUEDUTILITIES DEPARTMENT FOR CONSTRUCTION CONTRACTOR: sLe_ aoNST2UCT(oN ADDRESS: E• L381(0 12'0'1 AVE CITY: SPc)KAAV_ LOA ATE:' qqa\(0 PHONE: ga'1 -(0 lbs STATE CONTRACTORS LICENSE NUMBER . . : LC O A'4 l0 7,44, UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES (7 7) (CIRCLE ONE) INTERIOR ALTERATION WORK BY . . : -- ADDRESS: PHONE: CITY: STATE: ZIP CODE: *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING , SHOP , GARAGE, ETC THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION : # OF BUILDINGS / X 50.00 =5]/2722.g_ INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS _ X 35.00 TOTAL PERMIT FEE DUE $\ •0C) APPLICANT �� C��� SIGNATURE SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 ( 509 )456-3675