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1992, 07-14 Permit App: 92005259 Sewer S2-59 SEWER/PLUMBING PERMIT APPLICATION FORM 2- INFORMATION WORKSHEET7 O 7 6125 JOB STREET ADDRESS: `.--7,i//2-- G?' CITY/STATE/ZIP: 5/93/4 LA. 9g?-/t PARCEL NUMBER: MAILING ADDRESS: ---_ 43 // )- G?-i/ OWNER: .ci',e 6'/lf6 //e-v PHONE NUMBER: 9) -R 73 y (Street) (City/state) (Zip) CONTRACTOR: /,icf t=r/tti v -7&._ LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: - 'a / Ge-44. (Street) (City/state) (Zip) X EACH 4ai, � DESCRIPTION UNIT =AMOUNT (` q\17 9 SEWER CONNECTION X 50.00 = jo" \.0 p`9 i\ PLUMBING ALTERATIONS X 35.00 = �� '\. a SUBTOTAL $ ��,L L" EQUALS: TOTAL OP PEMIT FEE DUE =$ SIGNATURE �. - Spokane CouVepartment of Buildings West 1303 Broadway Ave ue Spokane, WA 99260 (509)456-3675