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1993, 03-31 Permit App: 93001982 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM -. \,-,:,,Li INFORMATION WORKSHEET ( . (5'11 ;" ^�, JOB STREET ADDRESS: /� �4 12- 7 CITY/STATE/ZIP: / _1 '/ if _ PARCEL NUMBER: \ OWNER::0..a-6 Aaa-I c ti PHONE NUMBER: 92_6 .-- 6, 93 / VA MAILING ADDRESS: D7ai-e-ii- ( J4 9 S2 (Street) (City/state) (Zip) CONTRACTOR: 5-?e-i.F LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: --S-;-rY7E (Street) (City/state) (Zip) jr- X EACH DESCRIPTION UNIT =AMOUNT 0L\-) � e SEWER CONNECTION X 50.00= SD,0-0 .� ' t() O` .-e PLUMBING ALTERATIONS X 35.00= t2\-' SUBTOTAL $ ���i;o-j �\ EQUALS: TOTAL PEMIT FEE DUE =$ 3 ,© ' SIGNATURE „4ad-e.-AtzeptSpokaCounty Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675