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1992, 10-05 Permit App: 92008415 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM 65 INFORMATION WdF KSHEET (,J JOB STREET ADDRESS: 1� -U = ` 4 63 CITY/STATE/ZIP: pry PARCEL NUMBER: `o" S MAILING ADDRESS: tm VD Co CW^ 'k' (Street) (City/state) (Zip) CONTRACTOR:'17mA--01A-G LICENSE NUMBER�,Q'M`5CE' L` l -,1 Y1 PHONE NUMBER:}}�� CI-256-MI I.0 ((�� MAILING ADDRESS: i'.0-C . tL l� SIrv�� cq 9. v-t -0/W (Street) (City/state) (Zip) IX EACH I I DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00 = 1Vv PLUMBING ALTERATIONS X 35.00 = SUBTOTAL $ 56 Citerik-- EQUALS: TOTAL 00 ,REMIT FEE DUE _$ . tj— SIGNATUR Sp ne County Department of Buildings West 1303 Bro way Avenue Spokane, WA 99260(509)456-3675