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1993, 03-15 Permit App: 93001495 Sewer
SEWER/PLUMBING PERMITARPLICATION FORM 013"lycls INFORMATION WORKSHEET 1 JOB STREET ADDRESS: Z. .� / � - �O CITYISTATEIZIP: PARCEL NUMBER: 011�NE L/ %u-C+L�G�ef�L PHONE NUMBER: [reef (City/state) (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (Citylstate) (Zip) West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 X EACHGiSI DESCRIPTION UNIT =AMOUNT SEWER CONN ECTION X50.00= PLUMBING ALTERATIONS X 35.00 = `IS( SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE _$ �✓ SIGNATURE L�3 r Spokane County Department of Buildings ct-7 West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675