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1994, 08-01 Permit App: 94007247 Sewer 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 N) JOB ADDRESS : / t7 9-('' PARCELONUMBER: CITY:_ C�%$ LG` STATE: It) ► f ZIP CODE: q7 ;) OWNER NAME: ©� oh___,7-"`e h5`eb ADDRESS: /O61f / p STATE: /A) / ZIP CODE: 79c:414' PHONE NUMBER: sq< )14/- 73g / PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO (CIRCLE • • _ *IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED. CONTRACTOR: Z- - .t.?)( (°011,51-(l k r--toll ADDRESS : 7E> ( (, CITY: )r' l' , . ;1 "_ STATE: ZIP CODE: ca 2,1 ?, PHONE NUMBER: '( / - I c l L( ( STATE CONTRACTORS LICENSE NUMBER: 2- (.;17 4) -1-e-- 7" '] --R H UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES 6D (CIRCLE ONE) INTERIOR ALTERATION BY: ADDRESS : PHONE NUMBER: CITY: STATE: ZIP CODE: *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION • # OF BUILDINGS X 50 . 00 = 565. e l INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35. 00 = ,�� TOTAL PERMIT FEE DUE $ .5O• zit APPLICANT ���� _ r c SIGNATURE: DATE: or SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675