HomeMy WebLinkAbout1992, 10-27 Permit App: 92009385 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATIOU WORKSHEET D�
JOB STREET ADDRESS: Lk+I
CITY/STATE/ZIP: PARCEL NUMBER: 1-/ oT L L _
MAILING ADDRESS: S.i
OWNER: I--f . , ,<L_t PHONE NUMBER: LO-L-
(Street)
`-L-(Street) (City/state) (Zip)
CONTRACTOR: H F S CunS4-ru_c1-1:6n LICENSE NUMBER: HSCo0 1-2:11C F
PHONE NUMBER: ctZta- BS62U
MAILING ADDRESS: E.. 11211 UauLeywa.1 AtJE. uJ F1. 997...(3(0
(Street) (City/state) (Zip)
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00 =
PLUMBING ALTERATIONS X 35.00 =
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE =$
SIGNATURE l '
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675