1993, 04-02 Permit App: 93002065 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM l�
INFORMATION WORKSHEET q - 5 - 1``''
ao(oS
JOB STREET ADDRESS: I O$V I C . (i-1^' �3
CITY/STATE/ZIP: Spolcu.a.i PARCEL NUMBER: ?2,OWNER: C r( Roe1X)`-1
MAILING ADDRESS: - �*"�`' PHONE NUMBER: 42.8- 36b 1
C,I \l
(Street) (City/state) (Zip)
CONTRACTOR: k+ S Com c.r' - rlwJ LICENSE NUMBER: Hi Cot.) 123 KF
PHONE NUMBER:
MAILING ADDRESS: C-• ( ( 17 Oct/1P-�'�`l °<« q9 2_.0 to
(Street) (City/state) (Zip)
X EACH
'SEWER
-
DESCRIPTION UNIT =AMOUNTOOD ^CONNECTION X 50.00 = S`'
PLUMBING ALTERATIONS X 35.00=
SUBTOTAL $
EQUALS: TOTAL
PEMIT F DUE =$ 5 6
SIGNATURE l
-i-1 6 .ne County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675