1993, 10-15 Permit App: 93009866 Sewer 452-c>14. 1 u* CI:3' c.
(Aa;J P1 SEWER/PLUMBING PERMIT APPLICATION FORM
Al I INFORMATION WORKSHEET ' 55 —8L7
JOB STREET ADDRESS: 10604 E 9th
CITY/STATE/ZIP: SPOKANE WA 99206 PARCEL NUMBER:
OWNER: MRS. HANSON (M.ax;e-) PHONE NUMBER: 924-7949
MAILING ADDRESS: 10604 E 9th SPOKANE WA 99206
(Street) (City/state) (Zip)
CONTRACTOR: FORD'S CONSTRUCTION LICENSE NUMBER: FORDSCC094C5
PHONE NUMBER: 509/924-6182
MAILING ADDRESS: 9713 E 4th SPOKANE WA 99206
(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 . 4 L-. /�f-gig-
Spokane County Department of Buildings
West 1 303 Broadway Avenue Spokane, WA 99260 (509)456-3675