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1992, 07-15 Permit App: 92005331 Sewer
SEWER/PLUMBING PSRM[T APPLICATION FORM Qa 5 -1, a INFORMATION WORKSHEET JOB STREET ADDRESS: /c_.32/ 2? �• 7AA 9a- 537/ CITY/STATE/ZIP. Alt//-. PARCEL NUMBER: //nO OWNER:UtG/y 7A -Lie bAe2-f- PHONE NUMBER: 9aeS•-5 .S„29 MAILING ADDRESS. y�(Stree) (City/state) (Zip) ✓ CONTRACTOR2'. 62rCAA/C LICENSE NUMBER: PHONE/NUMBER: la 7 a7 ('J MAILING ADDRESS: 7'9774.. �• /274— Gj _S D 91�/W4 /24 922/6 (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT =AMOUNT X50.00= _Crd, 0 0 X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =LSO.0 0 SIGNATURE -4P i Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675