1992, 10-27 Permit App: 92009367 SewerSEWER/PLUMBING PERMIT APPLICATION FORM CO- S -1DC\3
INFORMATION WORKSHEET
JOB STREET ADDRESS: G • 13 /2. / f cicL- to -1
CITY/STATE/ZIP: S V e d7),4 PARCEL NUMBER:
MAILING ADDRESS:
OWNER: PHONE NUMBER:
(Street) (Citylstate) (Zip)
CONTRACTOR: A-, 4 C 7`1 v6 LICENSE NUMBER: 4 frvA `(4- '- /060/65--
PHONE
v(p/)5'PHONE NUMBER: 9 22. —P v
MAILING ADDRESS:
(Citylstate) (Zip)
(Street)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE
X EACH
UNIT
=AMOUNT
X 50.00 =
X 35.00 =
SUBTOTAL
$
EQ ALS: TOTAL
%PIT FEE DUE
=$
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675
51