1993, 05-18 Permit App: 93003677 Sewer w
SEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS:___.--f _'L_l_-,-!_ _-_•' Lf
CITY/STATE/ZIP;_ tel,4, PARCEL NUMBER: — -- ---
MAILING ADDRESS: __. ._
__--
(Street) tU tv/state) (Zip)
CONTRACTOR:' - 1._-S- je- LICENSE NIJMBER:__ Zi._ jC_6
PHONE NUMBER:---f-Y •-7 ! 0_ -_
MAILING ADDRESSP.5s._.._ t_ i.5 _ _ _ _______
(eStreet'? (City/state) (Zip)
IX EACH ,
_ DESCRIPTION UNIT !=AMOUNT
(SEWER CONNECTION X 50.00
(PLUMBING ALTERATIONS X 35.00 =
SUBTOTAL is
EQUALS: TOTAL I Oa
.4 PEMIT FEE DUE !.-$ .
—
SIGNATURE 1
ane County Department of buildings
I
West 1303 B •adway Avenue Spokane. WA 99260 (509)456-3675