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1993, 03-15 Permit App: 93001497 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM 3_ kl{R1 r OnDRMAAOTION WORKSHEET JOB STREET ADDRESS: J1/o/1 - G- . ,/U;-->zse 3 CITY/STATE/ZIP: PARCEL NUMBER: MAILING A RESS: OWNE • LZZr--- {U �+- z PHONE NUMBER: (Street) (City/state) (Zip) CONTRACTOR 24 LICENSE NUMBER: �/ PHONE NUMBER: CJ' {P%dS. MAILING ADDRESS: (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT SEWER CONNECTION X 50.00 = =AMOUNT 5 up ©I&6'td PLUMBING ALTERATIONS X35.00 = V Taw SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$ SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675