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1993, 09-29 Permit App: 93008990 Sewer 1452-13. 2-3-I3 048 _ 135 rich A4CI, SEWER/PLUMBING PERMIT APPLICATION FORM cu - 8ci go 1-)3 INFORMATION WORKSHEET JOB STREET ADDRESS: ,/D 9 O t• 7 CITY/STATE/ZIP:eSPDX#9,01 (,OA 99.106 PARCEL NUMBER: MAILING ADDRESS: /D 9O / S,• 9 ' S pOH,1A)& (.)19 9 90t p (Street) (City/state) (Zip) CONTRACTOR: S/MASOAM. ,r rioc) LICENSE NUMBER: \.3/MASS X 14G2&L PHONE NUMBER: '902 (a- y>P/ MAILING ADDRESS: 78/ $6,94,46)/A) IDoknit) 9.902/0Z (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00= PLUMBING ALTERATIONS X 35.00 = SUBTOTAL $ g o, o p EQUALS: TOTAL PEMIT FEE DUE =$ SD. 00 SIGNATUREilifv4Le__) )41.1 Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675 REGISTERED AS PROVIDED BY LAW AS A: COT CONT SPECIALTY A REGISTRATION NUMBER EXPIRATION DATE • , (:•C'A 6)}ii SI MPSS,:":19zLc 11 /30/ 43 El:_CTI v OAT 06/03/.il a SIMPSON SANITATION .„.. • 7612 E bALDwIN •,,, SPONANL WA. 9921? SIGNATURE ISSUED BY DEPARTMENT OF LABOR AND INDUSTRIES 1 • . . . . , .. • .,s, . ,. •.1:: • , . •. . , ,„,, . • . „ , 11161ijqtii•IO!.tt,t0iiiit0:2-•gillf4iii0101100-41104•A!I:C4?,i1,.,,,,,,, • •, I • , •, , , • , , . ,„ „ . • • , . , . • . ,.„