1993, 04-15 Permit App: 93002503 SewerSEWER/PLUMBING PERMIT APPLICATION FORM cocc
INFORMATION WORKSHEET ��>� 7
JOB STREET ADDRESS: /S2®3 2�!,
CIN/STATE/ZIP: PARCEL NUMBER: G_ f
MAILING AD ESS:
OWNER: - PHONE NUMBER: /�'% .
( et(City/state) (zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/state) (Zip)
DESCRIPTION
SEWER CONNECTION
(PLUMBING ALTERATIONS
SIGNA
X EACH
UNIT
=AMOUNT
X 50.00 =
X 35.00 =
SUBTOTAL
$
EQUALS: TOTAL
PEMIT FEE DUE
=$
a° A
Spokane County Department of Buildings C�-
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675