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1994, 02-22 Permit App: 94001368 SewerGig-- ,0? qq5 - r7s 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. KNOWN) JOB ADDRE SS : r16 Z0 5 . 00AR Z,A. PARCEL NUMBER: Wk CITY=Je'b� V)W STATE: k ZIP CODE: liV RA OWNER NAME t M l LiNtiK) ADDRESS: kOD W CITY CKVAJ STATE:, Wfk PHONE: c/ WA -C�5 C� r PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? CES 42) RCLE c *IF PROPERTY OWNER CONSTRUCTIONINSTALLING REQUIREMENTS BEFOREFIRST PERMITCONTACT UTILITIES DEPARTMENT FOR ISSUED E, L3s16 i2 '` AVE CONTRACTOR: SLC- CONSTeUCT(ON ADDRESS: z,P ggaic� CITY: SPc= K A ( l. D A STATE -r. Gal --(0-1b� STATE CONTRACTORS LICENSE NUMBER ..: n -Cl �'t4 A -01-/M (,2 UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES NO (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 1 X 50.00 = 6"b,D INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 = TOTAL PERMIT FEE DUE $ APPLICANT }31 SIGNATURE SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675