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1992, 08-19 Permit App: 92006597 Sewer
te _ Lo5oti SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET g cJ c C` JOB STREET ADDRESS: CITY/STATE/ZIP:_', 1 x'-4' , PARCEL NUMBER: OWNER: `L-C_, PHONE NUMBER: 97,1e -- / ..'5.-": MAILING ADDRESS: ':---:',.2 ' .,' ".1-- (Street) (City/state) (Zip) CONTRACTOR:COUE.C►-tArINE EXCAVA'rio.I LICENSE NUMBER: COU eCC 'L1 B1 e'] U�f PHONE NUMBER: q a9-5485 �� MAILING ADDRESS: E . itogba VA-U.EyWAy AVE IrE2PcbALE WA 84037' (Street) (City/state) (Zip) X EACH a� , i,..)-3,:p- DESCRIPTION 3 a.� DESCRIPTION UNIT =AMOUNT 115 0� C SEWER CONNECTION X 50.00 = , /) �" "` \G� ��,�`a ' PLUMBING ALTERATIONS X 35.00 = � . 3 SUBTOTAL $ -5- 6, \ I �(C� �,� EQUALS: TOTAL V PEMIT FEE DUE _$ 3 ci_e) SIGNATURE (rte ,te ezlei/(Zi--i-c- Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675