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1992, 09-25 Permit App: 92008100 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM 9 a- '/o0 INFORMATION WORKSHEET JOB STREET ADDRESS: v7 E-71, 2 3 S, � �� I a© CITY/STATE/ZIP: PARCEL NUMBER: OWNER Ve PHONE NUMBER: 9SQ1-1- 9/ MAILING ADD ESS: - � (Street) (City/state) (Zip) CONTRACTOR: /. ( . LICENSE NUMBER: ff PHONE NUMBER: 9p27-4-1 7 0 MAILING ADDRESS:/ 2/‘ , � /-274) ��lJp/ �il/.EJ / . 999/6 (Street) 4 (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT �++�� SEWER CONNECTION X 50.00 = �. cJ **("1 C' PLUMBING ALTERATIONS X 35.00= SUBTOTAL $ ,I.,)e+c.AtZ•( " `. ;,,, EQUALS: TOTAL ( } 5 5LI s'C r I 0 PEMIT FEE DUE _$ 5 j `O R�. - c� Spokane County Department of Buildings I ` West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675