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1993, 06-17 Permit App: 93004756 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS U L� /� O "^' C^' Lk CITY/STATE/ZIP: 9 BIZ./ (, PARCEL NUMBER: MAILING PHONE l (Street) (City/state) (zip) CONTRACTOR: ALLC*15 ACTI\/E LICENSENUMBER: ALWAYA*104PP5 PHONE NUMBER: CIRR- 85CO MAILING ADDRESS: Yo•-15OIC 1915ba SftkANE WA gga,U (Street) (City/state) (zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT =AMOUNT X 50.00 = X 35.00 = OWBTOTAL. $ EQUA . OTAL PEMIT FEE DUE g5 f SIGNATURE Spokane County Department of Buildings 14Zr3. gZ31 q-3qW 93-yrt.S�