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1992, 08-24 Permit App: 92006759 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM c'-- \ INFORMATION WORKSHEET '.;.> � JOB STREET ADDRESS: /33/ 7 _67, `42/ Al CITY/STATE/ZIP: PARCEL NUMBER: MAILING ADDRE S: L OWNER: AAT 0 At/'y) PHONE NUMBER: c://_Q p7 - 1/02 9s— (Street) (City/state) (Zip) CONTRACTOR: 7. L- . G LICENSE NUMBER: ,_ ,� w l c PH NE MBER: _ - , MAILING ADDRESS: /-50/� «7h -y e ": "FA . 9 2/4, (Street) (City/state) (Zip) X EACH ,,�9 DESCRIPTION UNIT =AMOUNT ��ef c� SEWER CONNECTION X 50.00 = __S-'0. OQ )0,„.(C-4 PLUMBING ALTERATIONS X 35.00 = )0. SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$S-(,, 0 C31 SIGNATURE re--e -O-deek--(---,:z Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675