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1992, 11-30 Permit App: 92010447 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM (--ADL WORKSHEET E � . ( � � �. JOB STREET ADDRESS: -57 13°0 /3pNti e O 1 CITY/STATE/ZIP: 5A7 , LA-A 9Gg>6 PARCEL NUMBER: 7 (1 OWNER: /qieY ewe ePHONE NUMBER: MAILING ADDRESS: (Street) (City/state) (Zip) CONTRACTOR:Re,13r7-i A• Lo)O( LICENSE NUMBER: "Si PHONE NUMB/ER: 92/1- c71 `5 MAILING ADDRESS: • 94 i� �iqA-)D s / (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00= PLUMBING ALTERATIONS X 35.00= SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$ SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675