1993, 09-10 Permit App: 93008203 SewerSEWER/PLUMBING PERMi"i APPLICATION FORM 93-92-0
INFORMATION WORKSHEET
JOB STREET ADDRESS: 105n4 E Inthh Abq
CITY/STATE/ZIP: Spokane, WA 99200ARCEL NUMBER:
OWNER: Harlem D. Sandhprn PHONENUMBER: 926-1ae7
MAILINGADDRESS: S 480
(Street) (City/state) (Zip)
CONTRACTOR: ALLOA45 ACTHIE LICENSENUMBER: ALWAYA*1010P5
PHONE NUMBER: aR Hscb
MAILING ADDRESS: 0•-60y. 1915b -A S4OkANe WA 99a1t1
(Street) (City/state) (Zip)
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION
X50.00= 50.00
PLUMBING ALTERATIONS
X 35.00 =
SUBTOTAL $
EQUALS: TOTAL
olpatfhR�>s
PEMIT FEE DUE _$ 50.00 UN \` 5 5 ia�
SIGNATUR
Spokane County Departmenrof Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675
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