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1994, 01-18 Permit App: 94000367 Sewer
11,5213 ,q(yo - _ . �'�-3 �. � SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET qt-_$ -3q JOB STREET ADDRESS: / '' C.� C.. c 7 CITY/STATE/ZIP: C+t" Fes' PARCEL NUMBER: MAILING ADDRESS: � f "1(-- OWNERItt :3vr cI ':� PHONE NUMBER: (Street) (City/state) (Zip) CONTRACTOR: ALLAJP.y 5 ACTIV E LICENSE NUMBER: AL.WA1f Aif 10&425 PHONE NUMBER: 9 aa-8 'OO MAILING ADDRESS: 11.0 . �O,( 1 I5a S POkANE WA 9l9al q ' (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00 = 5'0 PLUMBING ALTERATIONS X 35.00= SUBTOTAL $ EQUALS: TOTAL �.- PE FEE DUE =$ 5 0 ,2 SIGNATUREIf r , Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675