1993, 03-12 Permit App: 93001445 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET 9 _ /IN
JOB STREET ADDRESS: I(-5-11"-- L . Z fl- ` S
J
CITY/STATE/ZIP: SOok , L.If) PARCEL NUMBER: 93S—
syy
OWNER: - 5,,.., R.-��q-r- PHONE NUMBER:
MAILING ADDRESS: —`r--,,
(Street) (City/state) (Zip)
CONTRACTOR: 1-1 tS LICENSE NUMBER: 1-( Co 123 K F
PHONE NUMBER: 92C-PAct6,1-(
MAILING ADDRESS: 1( XIS '- lLal..,) k � e:j`t ZGt,,
(Street) 1 (City/state) (Zip)
ep
X EACH 0
DESCRIPTION UNIT =AMOUNT
X50.00= �
SEWER CONNECTION9"1\) WM
PLUMBING ALTERATIONS X 35.00 = a`
1
SUBTOTAL $ 9 O
EQUALS: TOTAL � J
PEMIT FEE DUE _$ U 0%
-"r'--):L
SIGNATURE C -Th tikil f"
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675