1993, 01-25 Permit App: 93000362 Plumbing FixturesSEWER/PLUMBING PERMIT APPLICATION FORM �\
INFORMATION WORKSHEET �7
JOBSTREETADDRESS: I3311 E
CITYlSTATE2IP:_Eroo kcrto� LcrA. PARCEL NUMBER:
MAILING ADDRESS: 1,nue
OWNER: nan Slewyk PHONENUMBER: 9iB-21(o3 \
(Stt) (City/state) (Zip)
CONTRACTOR: H is QoN5T2ucYroreen( LICENSE NUMBER: _HSCON-0# 133KF
PHONE NUMBER: 926-M64
MAILING ADDRESS: E 11817 VALLEVkhY AVE SP&IcRNE WA 99a0(c
(Street) (City/state) (Zip)
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION
IX 50.00 =
So
PLUMBING ALTERATIONS
Ix 35.00 =
3f
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE =$ gS
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675