1992, 09-11 Permit App: 92007492 Sewer SEWER/PLUMBIN53 PERMIT APPLICATION FORM
INFORMATION WORKSHEET 1./--4g2 1 C
JOB STREET ADDRESS: L /33oS S/�1 4U ' /C a 6 `
CITY/STATE/ZIP;, La. 992/k PARCEL NUMBER: Li5= . I �J
MAILING ADDRESS: ,_S`dist6' -_ -�-�/
(Street) (City/state) (Zip)
CONTRACTOR: �..D�� z SrG�^ LICENSE NUMBER: -7-07 4LLS /.?' m
PHONE NUMBER: 9-242— 915"c(S
MAILING ADDRESS: /22g �f �- ` .
(Street) (City/state) (Zip)
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00=
PLUMBING ALTERATIONS X 35.00=
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE _$
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675