1992, 11-30 Permit App: 92010464 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM C V-1
INFORMATION WORKSHEET 095
l
JOB STREET ADDRESS: E . I O R l t 9-1-L•
CITY/STATE/ZIP: S' ok cn_0 , LArA PARCEL NUMBER:L OA
MAILING ADDRESS: :11/,4(.- CD\, ,_
OWNER: I1/442. C �� PHONE NUMBER: 9 24 3 2aS�
(Street) (City/state) (Zip)
CONTRACTOR: H$S Conc}.cl-ion LICENSE NUMBER: HSCoiJ lc 'E ►Z1 K F
PHONE NUMBER: 9Z-ii-runq
MAILING ADDRESS: £• t L t-1 UAL.L tAi Ai Pic. SPaKAk't., uJA• 997...W0
(Street) (City/state) (Zip)
X EACH V f Q�
UNIT = O��
DESCRIPTIONAMOUNT
'SEWER
��\ `N-2-CN-2—°\CONNECTION X 50.00 = 'PLUMBING ALTERATIONS X 35.00=
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE =$ gv
c= �
SIGNATURE lik L ' �
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675