1992, 07-09 Permit App: 92005095 SewerSEWER/PLUMBINtPERMIT APPLICATION FOFI
INFFORMATI9
/�%r tI /WORKSHEET
JOB STREET ADDRESS: / Y 01 / V
CITY/STATE/ZIP: (')/ /2 D ✓PARCEL NUMBER:
MAILING ADDRESS: /4 i /DO
OWNER: N�2y % N rk3 c7a/y PHONE NUMBER:
(Street) (City/state)
CONTRACTOR: 7724/ LICENSE NUMBER:
PHONE NUMBER:
PI),
MAILING ADDRESS: `�Iv, Aa -y /Y /440
(Street) (City/state)
7
y L LJ ZI `/ A *- i&0 PFJ
"�Ryly�
(Zip)
DESCRIPTION
(SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE
X EACH
UNIT
=AMOUNT
X 50.00 =
X 35.00 =
SUBTOTAL
$
EQUALS' TOTAL
PEMIT FEE DUE
=$
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675