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1992, 09-16 Permit App: 92007681 Sewer
SEWER/PLUMBINO PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS: ri CITY/STATE/ZIP: PARCEL NUMBER: i MAILING A DRESS: 1: l3 loS, •/7".--- ".--- f OWNER: .) PHONE NUMBER: Yv-'1 ' /1 6,7P-7) (Street) (City/state) (Zip) CONTRACTOR: HES CoNS72UcT►okl LICENSE NUMBER: NSC01•1.4+', la3KF' PHONE NUMBER: 926-89(04 ` MAILING ADDRESS: 118111 UAL-Le/AV AVE SPO k4NE WA gQa0(0 (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT/ SEWER CONNECTION X 50.00 = PLUMBING ALTERATIONS X 35.00 = SUBTOTAL $ EQUALS: TOTAL , REMIT FEE DUE =$ SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675