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1992, 10-14 Permit App: 92008629 Sewer I /---7---,\7__ ___) SEWER/PLUMBING PERMIT APPLICATION FORM �a _ ;p d INFORMATION WORKSHEETtt �� > 1 1 0 �% \ G1,r,- > 2-9 JOB STREET ADDRESS: via .41. DY CITY/STATE/ZIP: PARCEL NUMBER: OWNER: " _ A P -%� �_ PHONE NUMBER: MAILING ADDRESS: ..- /"` / -- ‘ - /C ^1 (.treet) (City/state) (Zip) CONTRACTOR: ALIA)4 AC.lV E LICENSE NUMBER:_fl A A.*10(oP5 PHONE NUMBER: 92- 85eP -Po. Y. /4lsba SiookANE WA- 99a MAILING ADDRESS: (Street) (City/state) (Zip) DESCRIPTION SIM=AMOUNT 11111.1111111111111 SEWER CONNECTION X 50.00= PLUMBING ALTERATIONS X 35.00 = 111111111111111111111 SUBTOTAL EIIIIIIIIIIIIIIIIII EQUALS: TOTAL PE-MIT FEE DUE 4/1 SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane,WA 99260(509)456-3675