1993, 09-21 Permit App: 93008644 Sewer 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 .
T /Oto //�-fr1 ( IF KNOWN )
JOB ADDRESS:( ,�� nn PARCEL NUMBER:/� J
CITY:(A r21C2+1�C STATE: al ZIP CODE:Q/ =- AL2
OWNER NAME: ')/11„ I 472. ADDRESS: 1-1(11"--
CITY: STATE: PHONE:
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES 60
( CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER , THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED,.
CONTRACTOR:mDVACV)4/26;
ADDRESS DL/ . -( S
CITY: t_ �l��c-iv STATE: kL PHONE: 922-(X395- /P
STATE CONTRACTORS LICENSE NUMBER . . : (5r/19A(-
UMBER . . : (-XC ALC7)`-� : ?
UTILITIES INSTALLERS PERMIT NUMBER: 7
INTERIOR PLUMBING ALTERATIONS? YES N (CIRCLE ONE )
INTERIOR ALTERATION WORK BY . . :
ADDRESS: PHONE: •
CITY: 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 $
•
APPLICANT
SIGNA ' RE ( i/f%Li
(
/ )00
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 ( 509 )456-3675
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LICENSE B TYPE STATUS CONTRACTOR MAME CITY Fop Doff SPfrCODES OLD LICENSE NEW LICENSE 1 'CONSTRUCTION CONTRACTORS
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AA0FFRC0171,11 Cl A A A AFFORDABLE ROOFING CO MAPLE VALLEY 05/10,94 01 1,A TOZC.r217kB CC A A 10 I
AAAND.. 3 M A I 01111NGHAM 01/05/8/ 00 _ - • Rf07C 1,.23204 CC G A f0 /
AAANDC1131L1 CC A A A ANDERSON CO INC 0(11 INGHAM 07,05,94 AF CG AAA/0.6232M( ••' AIO7C..30801 CC 0 A TO L
AAAPPS.I33NP CC A A A APPLIANCE 510010 TACOMA 08,01,94 BG AIOZCI.O)OJ) CC A A TO Z
ARASPI1223Df C( A A A ASPHAL lING INC SUMN(R 08,01,94 01 ATOZC..010KG CC A A TO I '
RRBRC 0.099950 CC E A A BACKHOE D1011 CHEHALIS 08,08,92 BM SIOZC110II AS CC A A TO I
AABACS.26IPN CC A A A 6ACKHIII SIMvICfS PORT ORCHARD 02,04,94 01 RIOZC.0088D° CC E A TO I
AABELL0211MC CC G A A BELL CO LACUNA 07,03,82 01 AIOLC..110MK CC A A TO I
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AACON.1214RD CC f A A CUNSINU1111199 SNOHOMISH 11,12,92 01 ARR00002S60k AIOZHR5084N4 CC I P ID I
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AACONS108501 CC A A A CONSTRUCTION SERVICES BELLINGHAM 11,11,93 01 AACONSII140* RLPR II.C11080 CC 9 A 10 ( 1
AAC0050II4OF CC 0 A A CUNSIRIICIIUN SERVICES 5101111 08,15,90 01 AACONS108501 5107PBAIO4D:1 CC f A 10 / I
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AAGLA11110R0 CC E A A GI ASS LONGVIEW 06,20,90 BP CR AAGL000I/7L1 RVIMI.1099PD CC A A Y INI1
AAGLA..121LI CC R A A GLASS LONGVIEW 06,20/90 BP NOHILGS148P0 0AGLA80110R0 RVPC 0.1014 JP CC A P v P Cl.
AAGUTI1174DA CC G A A GUlt1R5 INC SEATTLE 02,28,86 Cr APGUTIVI5160 SVP N5D.088KN CC R A V P NF
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AAMASC.017JG CC A A A MASONRY CO ANACORTES 09/07/99 81 MS AMROBS.I YBLJ CC A A Y ROBE
AAPAI1027'L7 CC G A A PAIMIIN1, PORT ANGELES 06,21,81 CB CE AAPAID1185P5 AMROH50305PI CC G A 4 ROBE
AAPA11II01KU CI E A A PAINTING PORI ANGELES 05,07,91 CB RNR00..217RC CC G A 0 $0111
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AAAUARI20480 CC G A A DUALIIY REMODELLING SERi1LE 01,18,81 01 AWRR008CIO08 CC G A WARD DI___
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AASAMIR21SDM CC G A a SANTOS INSULATION.ROOFING EVERETT 03,14/81 01 AZE 141110/169 CC A A / 11111
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LICENSE • TYPE STATUS CONTRACTOR NAME CITY DEP DATE SPEC CODES OLD LICENSE NEN LICENSE LICENSESTT TYPESTR1US CONIRpCII-
AASIGP1153JK CC G A A SIGNS PLUS SEATTLE 01,17/86 01
AASIMC.216PU CC G A A SIMMONS CONSTRUCTION CO DES MOINES 10,16,83 01 AZMOUC0IO71.6 CC E A 19901,141,
AASOLRC106145 CC E R A 501ID ROGUING.CO_ SEATTLE 97,)5,91 Co CV AZMUL.008146 CC A A l MEI:
AASTECII82N6 CC G A A STEEL CO INC SNOHOMISH 05,07,83 CK A2R000,088DP 4C E A l ROW
AA......98BW CC E A A Y INC SEATTLE 10,29,86 01 AYC00..221JS RI RLLSRIIINC CC E q-1 ALL !
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