1992, 10-27 Permit App: 92009394 Sewer SEER/PLUMBING PERMIT RMIT APPLICATION FORM
INFORMATION WORKSHEET qoaS- / I 0 3-
JOB STREET ADDRESS: C i)S)- 1--F1,\• 9 a-93 l C(
CITY/STATE/ZIP: evoke, c PARCEL NUMBER: �a 3�S
MAILING ADDRESS: S-60-K:.
OWNER: C (s'f,e Sr-t•.4, • PHONE NUMBER: --`i 22e kflumgot
(Street) (City/state) (Zip)
CONTRACTOR: H$. S G.ms4-rucl-i cin LICENSE NUMBER: HSC(30 ; 3 1 z..-0‹F
PHONE NUMBER: Ct2.(D- gScaU
MAILING ADDRESS: E.• I (21- JAuEft4J Aue. SPeKwe., W A. 992.Wo
(Street) l (City/state) (Zip)
XEACH '
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00 = ( Sc-)
PLUMBING ALTERATIONS X 35.00 = 1 3 c
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE Z --=$ C
r?" rp
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675