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1993, 02-03 Permit App: 93000591 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM q351- i INFORMATION WORKSHEET 9 JOB STREET ADDRESS: _ . / `3 1/ / ` _ � J �� OWNER: CITY/STATE/ZIP: _ PARCEL NUMBER:------_ n � 'iA( t; PHONE NUMBER: MAILING ADDRESS: (Street) (City/state) (Zip) CONTRACTOR: At-A_____ _ _---6-C-:--T/‘16'IS LICENSE NUMBER: AA�' A 1o�OPS PHONE NUMBER: 9a - 85e� MAILING ADDRESS: co.-- K /415ba SPOkANE WA 99a 14 (Street) (Cityistate) (Zip) DESCRIPTION MEI=AMOUNT / SEWER CONNECTION 4 X 50.00 - 111111111111111111 �`�/ IMMNMIII PLUMBING ALTERATIONS 5.00 = SUBTOTAL 01111111111111111 \eEQUALS: TOTAL 0 PEMIT FEE DUE SIGNATURE a/ Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675