1993, 06-25 Permit App: 93005142 Sewer43 - 64
SEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION
FORMW USTNBE OT FILBE LED
OUT ACCURATELY AND IN ITS ENTIRETY
AND SIGNED
(IF KNOWN)
JOB ADDRESS: /0 r� PARCEL NUMBER=
CITY' __._---
STATE: ZIP CODE:
��'�
OWNER NAME: I� ADDRESS:
�
d PHONE:
CITY:_-,_�_� - STATE:�G'i-
YES
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? (CIRCLE(ONE)
*IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: +`^RCtI AINE EXCAVATION ADDRESS: E No---qo.Q 22 LEY WAY /tY6
2!P ggo3 PHONE: aaq- X85
CITY: VEkA'1.E DAWP. `�''-�
STATE CONTRACTORS LICENSE NUMBER-:
Cou 2CC* 1812'7
UTILITIES INSTALLERS PERMIT NUMBER:
aYES INTERIOR PLUMBING ALTERATIONS? NO CIRC ONE)
INTERIOR ALTERA,T9ION WORK /BY.-: C/
ADDRESS :,L����>l�� '^�) PHONE:
- X /CX�L STATE:' - ZIP CODE:
CITY:e
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE ETC
THAT WILL BE CONNECTED TO THE SEWER.
d-8
k OF BUILDINGS �- X 50.00 =
FSEWERONNECTION...... X 35.00R PLUMBING �A/LTERATIONS: N OF BUILDINGS A -B
V "5t L' TOTAL PERMIT FEE DUE S
APPLICANT
SIGNATURE.
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675