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1992, 11-23 Permit App: 92010231 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM ( 2 INFORMATION WORKSHEET & Z , 4/40N, JOB STREET ADDRESS: E A-9c 0 9 r-lc -- cit CITY/STATE/ZIP: c›j-�Q—�j - 6e---4 - PARCEL NUMBER: --- - . OWNER: /— PHONE NUMBER: ��1 0 �`��-- MAILING ADD S: (Street) (City/state) (Zip) CONTRACTOR: Q .l.HA1NEo EIGCAvADON LICENSE NUMBER: 0-01.1.2CC*189.-Rl PHONE NUMBER: gay -5H85 MAILING ADDRESS: E. 1(04Oa VALLE'iWPd kvs VEeADAL-E WA CR037 (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNTS � " SEWER CONNECTION X 50.00= 6---(-) a'-- -.? CR PLUMBING ALTERATIONS X 35.00= �� WC� 4 > � SUBTOTAL $ — I A\ t EQUALS: TOTAL PEMIT FEE DUE =$ 6� SIGNATURE 1..-1 - \IN1 Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675