1993, 06-07 Permit App: 93004542 Sewer q@A"5- 2L 3Z(c • 4 , 93 -Y5 (12,
CP ‘cvs ,s‘kt 0L,b oeo., (3.3S- 373
lx I I fr1 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 .
//A< ( IF KNOWN )
//c / 7JOB ADDRESS: , , n PARCEL NUMBER:
CITY: I �1 ASTATE: (A)/A. ZIP CODE:
OWNER NAME: SI: to A ADDRESS:_( I 7 ,_ I '-
CITY: STATE: PHONE: -1 aa- 0 / l 0
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES YISCLE ONE )
*IF PROPERTY OWNER INSTALLING SEWER , THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED .
CONTRACTOR: TLC CoNST2ucTIoN ADDRESS: 6 . 1381(o )2.. /WE
2.19g9otllo PHONE: q21- c01lo0
CITY= SPOKr'�N� WA �E'
STATE CONTRACTORS LICENSE NUMBER . . : Cco it 101 Mlo
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES ( 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 I X 50 .00 = s), 'U C')
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35 .00 =
TOTAL PERMIT FEE DUE RECEIVED
JUN 71993
APPLICANT
SIGNATURE..X9. (1.6-GCJI,C ,et�1 '' / CODE ENFORCEMENT
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 ( 509 )456-3675