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1992, 06-18 Permit App: 92004492 Sewer
q2-tLL91 SEWER/PLUMBING PERMIT APPLICATION FORM ct z-41493 INFORMATION WORKSHEET O54--{ JOB STREET ADDRESS: �� /1-//0.140' J. GOOLFCRE.S` 9,2.3- (93(4 CITY/STATE/ZIP: ,' 0. PARCEL NUMBER: OWNER:/Jc/, ,'A GOA,- G PHONE NUMBER:g21' a3 I/ MAILING ADDRESS: (Street) (City/state) (Zip) CONTRACTOR: H SCzNSlaic TIoN LICENSE NUMBER: 1-fSCON aM'IZ3KF PHONE NUMBER: G2(0' 891vq MAILING ADDRESS: ty. 118I'1 URu-E`1WA`l WE SPOk.ANE WA GlcQD(o (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS X EACH UNIT =AMOUNT X 50.00 = X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE C =$ �V 452(a 2 3208 EAR-cq pAL 4 2nd L-8 I 1-a( 3084 SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675