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1994, 03-14 Permit App: 94001979 Sewer
4145 z 7 SEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT BE ISSUED. ,(IF KNOWN) { CliSz � JOB ADDRESS : nyin -1 F J D 11 II PARCEL NUMBER: CITY: PPl ( L3( STATE: (figs 4t ZIP CODE: g1C1)-0�p OWNER NAME: 7 �`I�-�4 � � �ADDRESS : Q n (- loft �w XU , I +' ' CITY: 5t 1Gr4LJ1 STATE: tx YPCS tt ZIP CODE: Cig PHONE NUMBER: •'L Zy ' p-r7V PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES EIRCLE ONN) *IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED. CONTRACTOR:I 01)1 4-1 Da C F*co." ni ADDRESS: I 1 1 2. M r n'1 c�' CITY: <,nnX-vl '1 E, STATE: WF- ZIP CODE: G 2((o 1 PHONE NUMBER: 42 e - 771 t0 STATE CONTRACTORS LICENSE NUMBER: T L ->F- ) U ( -u M UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? NO (CIRCLE ONE) INTERIOR ALTERATION BY: ( ')AU PALI t1 (.* inn. ou-i (> L/ ADDRESS : PHONE NUMBER: 32R 7_04 ` CITY: C-7pp(f.Tr% STATE: r1DAc11 ZIP CODE: _ ____________ _____ *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION • # OF BUILDINGS X 50 . 00 = S )--- INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS / X 35. 00 = 35.E 4E-moot ��-�^+p X11 SASE. flIEi-7T TOTAL PERMIT FEE DUE $APPLICA lG� SIGNATU �'/q y� // DATE: 3- ILLI -` SIGNATURE: ��� AC or SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675 • .;es " """",.""" . ". ".7 "" .. .. .. .... .... .. ... nn .......p.....4aaaaat221 0 37 1 30777724 ;;.. , 2422 2 y: PiiiiiazIR Was.aa a 4.........1111 Inn • 5 I - 5 5 5 5 a 1 2 1 1 1 5 1 1 1 C R 05 5 i Y E C ... . . .. vY Y E : E .•. .. I :1212111221t21... IG __= Y `.ee-e e'ee a-e.-e" .. 'e e "-e.'.'e'ee 'e .. .ero :6F i-F"..::6 3 R".:R ; FS 3: 3#3 _ 122 " FR"'•"»R:_ _3. F»•"_ " .. - .3 _r G __ ___ _ _o o_ EE .:[ ..-. S.S. ..< . ..< . .. _<. 1111 . . S6• -_ eC^_e=" ... - 21 Y- 2 - :: .. .: . . v 3, 35..41. .•]t Sf . : _.. 1 .- Y15 - ..• 5 "_Y a 5.:310 Y 5 .i a55aa1111i5315. .. 4 a5:... 3;1: f:::2. := ;11 7. a..= • ..fa E =YF.3_i: 0 2'_. a2G E_ .. . :37• _ 33:.,3 ii_.-. -. _-.»»:_Y ..1. i i:1:i:..l= 232.-1 C 11::.as 3:13111115?: 51 . 3 : arm .92 1111;1 I!! Ike:8Y=E.: Y - - Y - Y Y : Y Y Y- .r " • 22 -2 3- . Yid 2 .Y,E Y' 3.' " i a X ': S 5 :':'§':5E 333: =- S. . " 1 x 1 _5:5 35 _ i 'Ai 5 Y 3 1-525 a '6 i1:555 _ " 2 1 J 'sit _ V: 3" . : C n5 iSY ki Y'i YYy C„ .'. _.a 5 __..o .. :Y 1YYY• 1 1 1 :.322...« F--- .1111:i<E - :. p 22 .. 11141 15;1111115 1114511111151111111 31 37711 4 1 11 1111 1111 114411 :1 1 11 .1 .. ...ru.... . cw."441•44444 1+44 ...e.-400.......u.a--a.-.. ,.. .. X...1,5.1 .... .......... ... . ... 5 .. .. .. .. .. .. . . '3055 3 0 5 '3 3.15 a •glee: .:. 1'1'2;22"" y s5arie ,.-• = -: : x; i.1•sei 3:31 E ,7? n . :" d: 2 to ^V►2E .KO 5222„„ Ogg : 's 2 P MEI 535 1E3 I --"--5E5: a •,- 2. 3•„Y3 1 5:iihnt. :at; i 053 7 . 5,511511511n15$15 51511111511n1 $11111411111511515iiii111111 Po ligli1g14p1is mi11Siiiiiii22ifii111911d1 R 4 zy3 2 ' 1 @ . L 2i g {� a Y 2 1 : 1 f - . C�t f C 3 ii i Y Zr ±, r' C 5 : U 5 x 3 R• 3 All E e -. 3 n. B 1 i 5 i !1 1 X : 42 3 Ali ,. 0 31' 1 .. It 2 Ii I 35 . .. . . .............•........5......,.......•.••.1•.••.•..••.•.•:-1 - p . • .... ... -7. . - :1 ..<.. 1111 1.111 . 1 ,,,,,,Fa 111111F¢111141^ » F.. RF:FF RO:FRFa6FFFE 0 s FF :F 1 ::. FR. :; viz : """ F'''':.....:2:.R _. - 245:7 :'gii4:Mp:iii 7 0: E:/:_.::::: Utz: 42.1412 2ge 5.2_ .226^"":222122%6:c".......e 2 112 665:6 6pr7665:::7:l 5 v1 .L':FE.60.<FE.6 F'::.2"566 21t 2 6:5 .1