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1993, 10-11 Permit App: 93009624 Sewer
9392f 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 . KNOWN ) JOB ADDRESS: � � //%:=-7/22 &41f^ % PARCEL NUMBER: ,. J CITY: \� "_�c� 6P STATE: c? , ZIP CODE: 79c)9// OWNER NAME: 1(J0-,A) 0A ADDRESS: CITY: STATE: PHONE: 9ct1v -� PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YESNO ( CIRCLE ON *IF PROPERTY OWNER INSTALLING SEWER , THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED. CONTRACTOR: 14 4 S CO ILS rU C-Hior1 ADDRESS: 11. 811 E SOU l e_ d ate/ CITY: -6e01( U e STATE: WA gG2 PHONE: 5D . (12b • pel(o14 STATE CONTRACTORS LICENSE NUMBER . . : 14S CI 1E 123 c 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 n THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION # OF BUILDINGS / X 50 .00 = INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35 .00 = 00 TOTAL PERMIT FEE DUE $ APPLICANT SIGNATURE ( SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 ( 509 )456-3675 x • . .•....•. _ Vww,AmiNblomeNNNAAN NW A.....N.-±€0.124. X\No&N.N.WIAN.1.NINIWAAPIeldeliliNAP24•1%.1e. •AINA.N.V.e_XV.TVNANW,VVViel.ANVvNik-VilAr_le.•NEVV.N..%A.AiN.N.X.NI.M.N.AANINA.ANW%-milVv-XVINAAN.X.N.V.e. "0"...:i , DEPARTMENT OF LABOR AND INDUSTRIES 0,* . ,. THIS CERTIFIES THAT THE PERSON NAMED HEREON IS REGISTERED AS PROVIDED BY LAW AS A ..,. ;'.z.',. . ',.. ,. .' , •• ',v. 0 - ,.., •'' '' '., ''':.‘,..4'" .p, .. • ., ., - , t -`, .._;.' .,..„.4,• . - , • ,,-cikIrs-,- ,,.;,,tt'i 4'1;4.......GENERAL tR A L , : ' ' '' ' - --- -' . .. „ -.0:6M8ER,.:- ,'A:.!• ,:i '.-. PCPIPATK*OAlti. 0.1 ; ,, , # ‘*114f.,-. .,..- - -. ,I ,,. . 4Vi 04fE $0 /88 STATE OF WASHINGTON , ,01:,rxr4-- ,, ,, ,,;w..,,,-c`',-z-:,,,....-',-.2 -"..,...c- '- ,.,!,. '-..-:,.-.,...Y.‘,.4., ,,;,•;:.,-....: .,...,-;.: ',14f441i,-.f.- ii,_i ,l'i - : MtiOrtekl[.. -.1•• i'' ,`' ..,'':-., '';:,f' sv 0 : 1t4Otikittz,,,?',i'.',::,4,,.:::' ' :' . WA 99204' A.' ''''',:,,"..:;:;1..4•1';',....-', 1'...,•''','::‘,.';,,,',..- : ', , ',. . .. '',.,,'•:: ‘,: , ''' '''..•:''''''''.!'-';,.',.'5::.'.•'''.:...•':.-- - .: .'.. '• . ' '':.' .' . '' 111 .,. ,,i'.'i..;,.;•::i,.,:i..':,::' F625-052-000(3-92) _1 ' •. '. ,:. .../Nivvv..-NAN-NA,N,N.Ass,NNANx.a.Nivwv-vivvv\wv.v.vxmivx.ww..-w‘vvvvvvv.vvoANNANANNANA.k-vw.Amm.wv-ww‘NNNIvo.wkmA.N.kwv-wvolvw-wv.wv.Tvv_k-N.N. -k+4,.. . m.,,...4. - ';,,:.:'''',;:'' '‘;',.:''.i,:::i*,:'•::,,;.:; • • . .,.. ..., ..„,• .... . ,, , • --....,.,.-.,../:','- ,7. ''''''''''' .‘, .;+.P,,,, ,:74,t.;'.:14tt*OL R4-101404044, . , •. ! !::',..; :;''i :,.t.I.': # :.•41.4.:41#1•.•Ili.:*:::;.ss''''.-''''' "''' 4 0';' t :! ''' ''''s :r:) ,*,.4S..041 ..4'iil: ,'7.;5:'1:111110M!,f, .. 1!Ilitliti 4,„'!,•'-'!1-..l',:'•,L-.. :',..".' '" Iiii#11.40P#4,-, •':--:,, • .., . ..,.... :••••, ---,--- • ...,.. . .. • .... .. . ,.. . :....„,.. . .. . ,......... ,. .... ........ ...• - -. • • ,. ...