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1994, 02-18 Permit App: 94001344 SewerSEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT BE ISSUED. JOB ADDRESS: J /() CITY: -.S ''A'A-Q STATE: /dC? ZIP CODE: 91 9+ qi-ts Iv] (IF KNOWN) PARCEL NUMBER: OWNER NAME: y/Y CITY: PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES6-1°-) (CIRCLEONE) STATE: ADDRESS: PHONE : *IF PROPERTY OWNER 'INSTALLING SEWER, THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED . CONTRACTOR: r' S. Cp rk54-i1A r+hnn ADDRESS: 1 8 11 va4 `e: CITY: -6€0kflil� STATE: WA a 2 PHONE: 5oG - <1.. VGL`-. q o STATE CONTRACTORS LICENSE NUMBER..: 145 Cr) N )4'k 123 UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE) INTERIOR ALTERATION WORK BY..: ADDRESS: CITY: STATE: ZIP CODE: PHONE: *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION - it OF BUILDINGS X 50.00 = INTERIOR PLUMBING ALTERATIONS: It OF BUILDINGS X 35.00 = TOTAL PERMIT FEE DUE $ APPLICANT SIGNATURE f/f 1 `� SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675