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1993, 07-022 Permit App: 93006138 Sewer ►' G� ,i 1. ,' j � r Jima, r`-( r93 - 43 .2(P Lam- 6z_ 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 . ( IF KNOWN ) JOB ADDRESS: 1321 C- IV-l..- PARCEL NUMBER: CITY : COCcf=' STATE: G4 ZIP CODE: OWNER NAME: 16^^ i ,�t�r ADDRESS: - V-s...rQ q24—//(A PHONE: CITY: STATE: ( Th PERFORMING SEWER CONNECTION PROPERTY OWNER INSTALLATION? YES ' NO (CIRCLE ONE) *IF PROPERTY OWNER CONSTRUCTIONINSTALLING REQUIREMENTS BEFOREFIRST PERMICONTACT UTILITIES DEPARTMENT FOR ISSUEQ CONTRACTOR: ADDRESS: 1°67 5-. ( )Ld r: CITY: ' k STATE: t,rm PHONE: 3�Co- X4-7 ( STATE CONTRACTORS LICENSE NUMBER . . : N-S- w u tx (2-)31(-1 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 X 50 .00 = Jv INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35 .00 = TOTAL PERMIT FEE DUE $ APPLICANT SIGNATURE SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 ( 509 )456-3675