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1993, 03-12 Permit App: 93001442 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM 2S.`rZ- INFORMATION WORKSHEET JOB STREET ADDRESS: f_ CITY/STATE/ZIP: j IL/CPARCEL NUMBER: MAILING ADDRESS: SAW f / OWNER: r Ceic-- � PHONE NUMBER: (7 6 '��q �7 �'( treet) (City/state) (Zip) CONTRACTOR:(OM �-1.-6.24 E. LICENSE NUMBER: --r-vms-i-L, icy KcJ'�3'I PHONE NUMBER: q)--,y- `2 7 / d MAILING ADDRESS: )(` / / 1 I )114145/2_ A()IcA—ii 9q j--/L-1— (Street) /(Street) (City/state) (Zip) VPLC X EACHC,C DESCRIPTION UNIT =AMOUNT t SEWER CONNECTION X 50.00 = (SQ D--- PLUMBING ALTERATIONS X 35.00 = SUBTOTAL $ EQUALS: TOTALill Op ' P , IT v FEE DUE =$ 6,---_____ . / SIGNATUR / " . a = ounty Department of Buildings West 1303 : ,.adway Avenue Spokane, WA 99260 (509)456-3675