1993, 11-03 Permit App: 93010634 Sewer q3 ,/o1,3L
SEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET 6135 -q5q
JOB STREET ADDRESS:_ E 10314 6th
CITY/STATEJZIP:_.Spokane,_ WA PARCEL NUMBER:
MAILING ADDRESS: 1927 2"4r9 , gpnkan.e WA 99203
OWNER: PHONE NUMBER: 509-534-1987
(Street) (City/state) (Zip)
CONTRACTOR: ALEAJAy 5 ACTIVE LICENSE NUMBER: A LwAY Ave-iO(0P5
PHONE NUMBER: 9aa-8500 ,
MAILING ADDRESS: 4�.0 . t�O'( 1q 15(o 2 POkA * WA 99@A I
(Street) (City/state) (Zip)
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00 = n on
PLUMBING ALTERATIONS X 35.00=
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE _$ 50. 00
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675