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1992, 11-10 Permit App: 92009974 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS 10617 —w CITY/STATEI 14: PARCEL NUMBER: OWNER: PHONE NUMBER: lZol MAILING ADDRESS: - I /� (Street) (Citylstate) (Zip) CONTRACTOR: QA9WAINA EXAYAYION LICENSENUMBER: Q.OU2CC�`1S 1R7 "t PHONE NUMBER: gc1q -5LItT35 MAILINGADDRESS: E. I04Oa VAU.EYWRY NVS VE"PLE WA 99037 (Street) (Citylstate) (Zip) SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 `d1�