1992, 07-07 Permit App: 92005027 SewerSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET /
JOB STREET ADDRESS: /,32.2 J
CITY/STATEy ��/22ZIP: S' d/I(a-A'( PARCEL NUMBER:
OWNER: la ^ z i /A/ PHONE NUMBER: 92e1-1174/7
MAILING ADDRESS: � 'state) (ZIP)
�--��(Street) (City/state)
CONTRACTOR: /��LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS: %,J?/‘ -L /2 PpdAan-t 992,1
(Street) (City/state) (Zip)
DESCRIPTION
'SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE
X EACH
UNIT
X 50.00 =
X 35.00 =
SUBTOTAL
EQUALS: TOTAL
PEMIT FEE DUE ,
=AMOUNT
=$
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675