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1993, 03-23 Permit App: 93001696 Sewer
X31 (0' ( SEWER/PLUMBING PERMIT APPLICATION FORM 93s- ' lI INFORMATION WORKSHEET 3 JOB STREET ADDRESS: 13( L)Z 14 L \SCI CITY/STATE/ZIP: `loUk ) LA..PA PARCEL NUMBER: OWNER: Lir_(t,, Oat H-- PHONE NUMBER: CI 4-0 —(-03(0--) MAILING ADDRESS: i^ (Street) (City/state) (Zip) CONTRACTOR: HI-S _ LICENSE NUMBER: F(-S-Ccs 13 K PHONE NUMBER: 1%'tn" 1 U-1 MAILING ADDRESS: ` I g 17 C. UP,.-.(s-\L,,,,, '� "JL q92_00(Street) (City/state) (Zip) X EACH vjO(,FCK DESCRIPTION UNIT =AMOUNT � ICtj3 ,,,�() SEWER CONNECTION X 50.00 = qS W 00 PLUMBING ALTERATIONS X 35.00= `'l _ ,p SUBTOTAL $ 0 r- 2 �jJ� EQUALS: TOTAL J PcA- - LPEMIT FEE DUE _$ `� U SIGNATURE 1 c a` `>- Sp ne County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675