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1992, 11-13 Permit App: 92010077 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM S O a INFORMATION WORKSHEET JOB STREET ADDRESS. CITYISTATEIZIP. �j"{Y1Y.�t1C PARCEL NUMBFH- MAILING ADDRESS.__.. Stieotl (City/state) _ (zip) CONTRAC iOf�Q'(��bSY� LIC EivSE ^i UIN b'ER�Y��,i[�,..�1{,��✓� f'HONI3 NUQMCB}E�N MAILING ADDRESS.0 �� I(k�.sl.(. SRY4A" (Street) (City/statej (zip) YEACH DESCRIPTION IUNIT FlM110SaO0 (SEWER CONNECTION X6000�� PLUMBING AL1"ERATIONS X 35 00 S. CLQ ' _. 'SUBTOTAL.$ IEQUAW TO! AL �PEMIIFFE DUE =S '6 SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, 'WA 99260 (509)456-3675