1993, 08-17 Permit App: 93007088 Sewerg5zl'�. clz-3,y ►
93 - V088
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)
JOB ADDRESS'
r� / PARCEL NUMBER:
---�
STATE=---�121 ZIP CODE:
CITY:
/o
v2�� ADDRESS:—te�8'2/ N
OWNER NAME:��/! ��}}�/� r--
CITY: -�
STATE:�LLG. PHONE: 2 22 S
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES (CIRCLE ONE)
RST
*IF PROPERT
DEPARTMENTY OWNER SEWER, THEY MUST BEFORE PERMIT IS ISSUED.
UTILITIES
ISSUED
CONTRACTOR: AMSTEDN6(IONSTP CTION ADDRESS: �'�• 14z8Z-
'7�Pq�-0559
CITY: SPOKANE WP• S -T E; g9aW PHONE:
STATE CONTRACTORS LICENSE NUMBER..: A2M5-I G+1"19 oZ N1
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES (NV
INTERIOR ALTERATION WORK BY..:
ADDRESS
CITY:
(CIRCLE ONE)
PHONE:
STATE: 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 = �.
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $ !G
APPLICANT /
T- -
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675