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1993, 05-14 Permit App: 93003554 Sewer SEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT BE ISSUED . ( IF KNOWN ) JOB ADDRESS: /z/ /5 r / 3 7-6` s ( PARCEL NUMBER: CITY: S(0r) /<i4,,,r Z,- lam© STATE: ti09- ZIP CODE: ?9 ;) 6 3/9-4-Fri L.S ADDRESS: // /7/S1-02 Ate' / 7( S i OWNER NAME: 50,76 rL, CITY: ���/1,4r,��� ' STATE: I/\/4, PHONE: ( ? 7' / 3 37 PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? 411111 NO LE ONE) *IF PROPERTY OWNER INSTALLING SEWER , THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUER. CONTRACTOR: ADDRESS: CITY: STATE: PHONE: STATE CONTRACTORS LICENSE NUMBER . . : UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES NO ( CIRCLE ONE) INTERIOR ALTERATION WORK BY . . : ADDRESS: PHONE: CITY: STATE: ZIP CODE: • *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING , SHOP , GARAGE , ETC THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION # OF BUILDINGS X 50.00 = INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35 .00 = TOTAL PERMIT FEE DUE $ APPLICANT ,// /,:3j/./j SIGNATURE SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE ,WA 99260 ( 509 )456-3675