1993, 10-18 Permit App: 93009959 Sewer 45-2-Z-1 , Ii1r vJtem
PAArcji„,/1 l SEWER/PLUMBING.PERMIT APPLICATION FORM
C ,b1INFORMATION WORKSHEET
JOB STREET ADDRESS: E 131 2 3 8th
CITY/STATE/ZIP:Spokane WA 99216 PARCEL NUMBER:
MAILING ADDRESS: same y2�- /6yU
OWNER: Kevin D. New PHONE NUMBER:
(Street) (City/state) (Zip)
CONTRACTOR: Al WON S ACTIVE LICENSE NUMBER: ALWAYAve .1.0(0 95
PHONE NUMBER: 9aa-885OO
MAILING ADDRESS: Imo.O . O( Iy J 5(oa POkANE WA cf9aly
(Street) (City/state) (Zip)
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00= 50. 00
PLUMBING ALTERATIONS X 35.00 =
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE _$ 50 . 00
SIGNATURE d
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675
OCT 18 ' 93 9: 13 FROM HOWARD HERMAN PAGE . 001
OCT 18 '93 07:42AM P.2
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SEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY
AND SIGNED OR PERMIT WILL NOT BE ISSUED .
��� � � ( IF KNOWN )
JOB ADDRESS: PARCEL NUMBER:
CITY : OKE - STATE: W ZIP CODE: gy�- -6
OWNER NAME � �" ADDRESS- i /3)).3 g
CITY J Vim- '
STATE: W. PHONE: qa r- 7 C90
PROPERTY OWNER PERFORMING .SEWER CONNECTION INSTALLATION? (YESNO
CLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED?.
CONTRACTOR: S-44 ADDRESS:,
CITY: STATE PHONE: •
STATE CONTRACTORS LICENSE NUMBER. .:
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE )
INTERIOR ALTERATION WORK BY . . :
ADDRESS: PHONE•,
CITY: STATE: ZIP CODE:
wisals======== ==m1m======am.., ==e,Mas==r4am®====;sssss===sna=======mmum0
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE , ETC e
THAT WILL BE CONNECTED TO THE SEWER.
SEWER CONNECTION • # OF BUILDINGS / X 50.00
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 mT
TOTAL PERMIT FEE DUE 0 �j b% T!
.1.1111.1
APPLICANT qgt„,„;
s�-Y/7r1' G `
SIGNATURE
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 ( 509 )456-367S
. f-4C MR2
** TOT' AcE . 001 **