1994, 05-02 Permit App: 94004048 Sewer SEWER CONNECTION PERMIT APPLICATION FORM C1// 50)
*THIS APPLICATION FORM MUST HE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND
SIGNED OR PERMIT WILL NOT BE ISSUED.
E 13204 10th (IF KNOWN) -1/‘b113
J08 ADDRESS : PARCEL NUMBER: �-('
CITY: Spokane, STATE: WA ZIP CODE: 99216
OWNER NAME: Dennis and Laurie McRae ADDRESS: same
CITY: STATE: ZIP CODE:
PHONE NUMBER: 509-927-8431 /'
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES / NOS
(CIRCLE )
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR: Alwo.ts Avhdr- - ADDRESS : -I) r5 iv.. S?
CITY:,4fli/z/ly. STATE: WAh ZIP CODE: 3/42-04-
PHONE NUMBER: a2-2 - 435C)C
STATE CONTRACTORS LICENSE NUMBER: A LAAI A`I A -Yr 14)(. i S
JTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? /YES NO (CIRCLE ONE)
INTERIOR ALTERATION BY: Always Active
ADDRESS : P.O. Box 141562 PHONE NUMBER: 509-922-8500
�ITY: Spokane STATE: WA ZIP CODE: 99214
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION • # OF BUILDINGS / X 50. 00 = 50. 00
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS / X 35. 00 = 35. 00
TOTAL PERMIT FEE DUE $ 85 .00
APPLICANT
SIGNATURE: /7( 'J�{E_ti/ DATE: -;4,4/
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675