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1993, 06-22 Permit App: 93004931 Sewer s - 4L1� \l/•( V i,P J ��OI 1713, q3 ,L/c1 SEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED DUOUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOTBE ( IF KNOWN ) "I �� 1 JOB ADDRESS: /!/[/OL/ PARCEL NUMBER=1. 9. s i CITY' Ott' •f STATE: C4,44' ZIP CODE: OWNER NAME: (/ /0AN � LI ARC AODRE S: //640q 90-7-1/2 ��/ CITY 4 V /d STATE: 4 PHONE: (O PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES( CISCLE NO *IF PROPERTY OWNER INSTALLINGREQUIREMENTS BEFORE IPERMIOTNISCISSUEDUTILITIES DEPARTMENT FOR CONSTRUCTION CONTRACTOR: TLC CoNsTeucTloN ADDRESS: E t 381(0 12.111 PcVE ?Ip g9o�Ito PHONE: q27" (01t00 STATESPOKPcN& WA s-T- E7: STATE CONTRACTORS LICENSE NUMBER . . : TL.000a��E 101 M(o UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? 40110 NO (CIRCLE ONE) INTERIOR ALTERATION WORK BY . . : Y �CY� 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(Q ,690 PLUMBING ALTERATIONS: # OF BUILDINGS X 35 .00 = 4U• ©® INTERIOR ,�^ ��Oa q3 4-1/6134Q TOTAL PERMIT FEE DUE APPLICANT /`1� �`�• SIGNATUR SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 ( 509 )456-3675