1993, 08-09 Permit App: 93006788 Sewer corfv\rlif vkloLciAl\larl q3
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SEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION FORM MUST BE FILLED
ACCURATELY AND IN ITS ENTIRETY
AND SIGNED OR PERMIT WILL NOT BE
( IF KNOWN )
/ , l 7-" PARCEL NUMBER:
JOB ADDRESS:
CITY: _
STATE:/-f L' . ZIP CODE:
OWNER
ADDRESS: &.---- '/442 7/ 7
NAME: �A /�� ��
CITY:
• STATE: Al PHONE: %a� U
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YCE
S 0
( SCLE ONE
*IF PROPERTY OWNER INSTALLING SEWER , THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED .
CONTRACTOR: RCS AI NE EXCRVPrT10N ADDRESS: S- VOLLOR U.114.4.E LOAM MG
2AP gg03 PHONE: qay- 5 85
CITY: \leeNDINLE VJ P�
STATE CONTRACTORS LICENSE NUMBER . . : Couecc4kisigi
UTILITIES INSTALLERS PERMIT NUMBER:
IOR PLUMBING ALTERATIONS? 6-1E- NO (CIRCLE ONE) `� -
INTER 1
INTERIOR ALTERATION WORK BY . . : L ♦ r'
L// - / PHONE: 7 /�- 51/
ADDRESS: //�7`"
id/�
CITY: '' ZIP CODE:STATE:(�[•L�
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING , SHOP, GARAGE , ETC
THAT WILL BE CONNECTED TO THE SEWER.
SEWER CONNECTION # OF BUILDINGS
l X 50 .00 =
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS
X 35 .00 =
TOTAL PERMIT FEE DUE $
APPLICANT
SIGNATURE /41. e 62-6(-4-4'
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 ( 509)456-3675