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1993, 08-09 Permit App: 93006783 Sewer
Cot;D oa _ E- 1yy a 10‘' S42 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 KNOWN ) 0 �_ A PARCEL NUMBER: JOB ADDRESS: r ! nn 0 -- STATE:141, ZIP CODE: CITY ' ER NAME: Ar -- A 46 ADDRESS: f O liD E lR OWN - CITY A-f1IF STATE: (,tJA , 1rS1 PHONE: 1 06, PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES (CIRCLE ONE) *IF PROPERTY OWNER INSTAGSEWER , THEY MUST REQUIREMENTS BEFOREIRST PERMIOTNISCISSUEDUTILITIES DEPARTMENT FOR CONSTRUCTION CONTRACTOR: TLC CONSTP-UCT10N ADDRESS: E . i38I(O 12 AVE ?JP L19o�1to PHONE: ci 27- (olloO CITY: SQOI(PcN E J Sfit�1`E' STATE CONTRACTORS LICENSE NUMBER . . : 71....0004t-iE i01 Mb UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE) INTERIOR ALTERATION WORK BY . . : ADDRESS: PHONE: 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 = S D ' NO INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 = ' ©� TOTAL PERMIT FEE DUE $S� APPLICANT A. SIGNATURE %` ` SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 ( 509 )456-3675