1993, 10-15 Permit App: 93009868 Sewer 452*I'll -q,04
btrh.4 pi SEWER/PLUMBING PERMIT APPLICATION FORM 135 �1�
INFORMATION WORKSHEET
JOB STREET ADDRESS: 10622 E 9TH AVE
CITY/STATE/ZIP: SPOKANE WA 99206 PARCEL NUMBER:
OWNER: MRS. HANSON PHONE NUMBER: 924-7949
MAILING ADDRESS: 10604 E 9th SPOKANE WA 99206
(Street) (City/state) (Zip)
CONTRACTOR:FORD' S CONSTRUCTION LICENSE NUMBER: FORDSCCO94C5
PHONE NUMBER: 509/924-6182
MAILING ADDRESS: 9713 E 4TH AVE 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 Ref...., 40--a--
Spokane
County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675