1992, 10-07 Permit App: 92008542 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET Ct a - lb (
�o
JOB STREET ADDRESS: E. 1`31c3 i t-I-1,.' a Z5y
CITY/STATE/ZIP: Scolccnp, terra. PARCEL NUMBER:
MAILING ARDRESS: (r\ccN q OF 162nd Aum.) �.1.ncc.t..naer) Larp 9RG,c,2-
OWNER: 1+1-e 1kt�5t r, PHONE NUMBER: I-2c.14.-2.5 3- 2.a<7
(Street) (City/state) (Zip)
CONTRACTOR: 14 t S CtoN571211CTroi1 LICENSE NUMBER: HSCON ,l 12.3k,g
PHONE NUMBER: 6126-89/4 A
MAILING ADDRESS: E 11817 VAU_EVAY AVE 3POkPrNE WA 990016
(Street) (City/state) (Zip)
X EACHE-
DESCRIPTION UNIT =AMOUNT WO�r
SEWER CONNECTION X 50.00 = I SG `I 11 t
PLUMBING ALTERATIONS X 35.00 = 4 5
SUBTOTAL $ S 6 f2 5
JeicJ1
EQUALS: TOTAL \(Y OD
PEMIT FEE DUE =$ Sc) 6 (
SIGNATURE a
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675