1994, 01-03 Permit App: 94000046 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION� WORKSHEET
JOB STREET ADDRESS: 5 3 �7�Y/
CITY/STATE/ZIP:
?O PARCEL NUMBER:
MAILING ADDRESS: - 9-44 F -
OWNER: LL/A-1- S/ -I PHONE NUMBER:
(Street) (Citylstate) (Zip)
CONTRACTOR: A LLJP`) 3 ACTI V E LICENSE NUMBER: A LWAy A •f 10 (fli25
PHONE NUMBER: 9aa-8500
MAILING ADDRESS: Imo• O . --BO( Iy) 56)a S POkAm WA ci9aI 1
(Street) (City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE W9.-11 c7
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675
X EACH
UNIT
=AMOUNT
X 50.00 =
$1
X 35.00 =
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
_$
5-6