1992, 07-21 Permit App: 92005562 Sewer SEWER/PLUMBINC PLRMIT APPLICATION FORM °\-D ,SS b2
INFORMATION WORKSHEET Z 5 - 7 ZS
E
JOB STREET ADDRESS: 13 C9 D 7 1-4
CITY/STATE/ZIP: SiOk o/& £JA.9VotARCEL NUMBER:
MAILING ADDRESS: 13 (o O T E 1''
OWNER:W 1 t. - Gi4.ssen PHONE NUMBER: x-09 .5/4(7 -35//2_,
suwAys roe (Street) NEWPo ger Wetity/state) 99/4gip)
CONTRACTOR: £ Lp LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS: / 4,2 SemmysiDcr IJ�c'1ri,anerth ?q/4-6,
(Street) (City/state) (Zip) ,p,c
X EACH
DESCRIPTION UNIT =AMOUNT L 5aa t . 132 co
SEWER CONNECTION X 50.00= pubes H M
PLUMBING ALTERATIONS X 35.00 = *50(Les
SUBTOTAL $
EQUALS: TOTAL L 3 )
PEMIT FEE DUE =$
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675