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1992, 09-16 Permit App: 92007688 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM --- 1I� ' INFORMATION ORKS*riEET L `"` 3 v JOB STREET ADDRESS: G r Z----?3e) C' - 8" — /CC-ALCV-ie C�;S' \ CITY/STATE/ZIP:\i24 . C '67 PARCEL NUMBER: — MAILING ADDRESS: .../; /,>.,----- . '- � ��1 OWNER: Ci ,1'. C_c-V_i' PHONE NUMBER: 97,124Z- '.-5--- 2-7� (Street) (City/state) (Zip) CONTRACTOR:Q Ue UPdNE EXCAvWiriou LICENSE NUMBER: dou acC At 184 r1 PHONE NUMBER: cta4'v485 MAILING ADDRESS: E. tipLia2 UAUEYWf V 4k' Vee DA-1e WA- 61`1037 (Street) (City/state) (Zip) X EACH ` ,,Ql��` ` DESCRIPTION UNIT =AMOUNT �" LP SEWER CONNECTION X 50.00 = _ ---e) 4`.----5-' \_Sc gA• \ �5 PLUMBING ALTERATIONS X 35.00 = `�, ' ' SUBTOTAL $ `fir a- 06)4 EQUALS: TOTAL PE MIT FEE DUE =$ c • SIGNATURE £6 • 6-e_c': /act.-�e-Q' 1 Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675