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1992, 11-23 Permit App: 92010232 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM CoINFORMATION WORKSHEET Com. Co ( ' 5--------) JOB STREET ADDRESS: g'• 43 /10 ( — Q CITY/STATE/ZIP: �— .-D - G(' ` PARCEL NUMBER: 1 OWNER: (i � sd----- PHONE NUMBER: , P — �O s /' - 22'-.))MAILING ADDRESS: �--� �� (Street) (City/state) (Zip) V rc-)CONTRACTOR: NA1NE EIGCAv'ArION LICENSE NUMBER: t,.,OUfZCC4`181-R�7 K �,�PHONE NUMBER: qa 4 -54 �s85 B MAILING ADDRESS: E• t(DUOD. VALLEyWPci AVE VE2 .bP LE WA 91037 (Street) (City/state) (Zip) cc-,1 X EACH DESCRIPTION UNIT =AMOUNT Vv ( a�` ALN I �i� �cl, SEWER CONNECTION X 50.00= '�'`� �(SU PLUMBING ALTERATIONS X 35.00= -26 mmC'� SUBTOTAL $ 8"5 0 A- 4 EQUALS: TOTAL y PEMIT FEE DUE =$ 1- ' SIGNATURE '�'..% - 6-e-eJLP ) LP-e--L-Q Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675