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1993, 07-20 Permit App: 93006059 Sewer 1.4 c33 53 q3 q SEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT BE ISSUED . ( IF KNOWN ) JOB ADDRESS: 1 ) 10`; C , C3 41^• PARCEL NUMBER: CITY: S(DIko-sz STATE: (Air ZIP CODE: OWNER NAME: I)cr, ]T,�c 4�'�r ADDRESS: -- 54-0-t-51, CITY: STATE: PHONE: i 2y - 2403-1 PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES N ( CIRCLE ) *IF PROPERTY OWNER INSTALLING SEWER , THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.. CONTRACTOR: pf3 ADDRESS: J ? CITY= 1c..., STATE: wn PHONE: iago- Yi(.oq STATE CONTRACTORS LICENSE NUMBER . . : 1-I-S- Cc, J 'r 123K F UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES :' ( CIRCLE ONE ) INTERIOR ALTERATION WORK BY . . : 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 = INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35 .00 = TOTAL PERMIT FEE DUE $ <L) APPLICANT SIGNATURE SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 ( 509 )456-3675