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1993, 08-09 Permit App: 93006786 Sewer 4sz-I 3 , 086 O3- (07 3 G3 - Vi gL AL4c A-Qb Q - -18(19 i. S 400c( hl OLS ©�1��42o 5 °l 3 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 . / ��Q ( IF KNOWN) JOB ADDRESS: / (i / `7 , / / 1- PARCEL NUMBER: CITYSTATE: 60/A', ZIP CODE: • • OWNER NAME: //11\_ kik LE ADDRESS: t1 11-7 E-' I Ar CITY•J�pe f=, —20STATE: ._ PHONE: qGy �� (9 ' YES NO PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? ( CISCLE ONE) *IF PROPERTY OWNER INSTALLNGSEWER , THEY MUST REQUIREMENTS BEFOREIRST PERMITNISCISSUEDUTILITIES DEPARTMENT FOR CONSTRUCTION CONTRACTOR: TLC CONSTenCTbON ADDRESS: E . i3S1(o )2.111 PtVE ?JP ciciRIto PHONE: qa7" (07100 CITY: SPOKPcNE VVA ' STATE CONTRACTORS LICENSE NUMBER . . : -TI,CCO i 101 Mt0 UTILITIES INSTALLERS PERMIT NUMBER: _ Clc 7gq INTERIOR PLUMBING ALTERATIONS? gilk NO (CIRCLE ONE) INTERIOR ALTERATION WORK BY . . : /6 �� k PHONE: HONE: ' 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 = 56 , 00 INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 = 3. TOTAL PERMIT FEE DUE S APPLICANT ..,/,(9 SIGNATURE SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 ( 509 )456-3675