1993, 02-16 Permit App: 93000872 Plumbing ReversalSEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS: )341, r- IL
F L^
CITY/STATEIZIP: :�2.t�1,� � PARCEL NUMBER:
MAILING ADDRESS: -<A i41
OWNER.' --j s PHONE NUMBER:
(Street) (City/state) (zip)
CONTRACTOR: HES LICENSE NUMBER: HSCorJs 'F i7,ZKF
PHONE NUMBER: 9 2.1s- 45wq
MAILING ADDRESS: E.1181� l)eu. 4wT gdj 801E.. ipeeayq wri. 992,0(n
(Street) (City/state) (Zip)
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION
Ix50.00=
PLUMBING ALTERATIONS
IX 35.00 =
? T
SUBTOTAL Is
EQUALS: TOTAL _
�(/ g PEMI1 FEE DUE _$ g
SIGNATURE 1
��cT Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane. WA 99260 (509)456-3675