1992, 07-20 Permit App: 92005276 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM cA-2__ S a-
INFORMATION WORKSP11EET CD1a S - 7O ct
JOB STREET ADDRESS: 14704 Ai
/9/-h ✓
CITY/STATE/ZIP: Ueradc f WA gctO3 7 PARCEL NUMBER:
MAILING ADDRESS: 3A M LE-
OWNER: 1\-11
OWNER: .Mi ke MuIier— PHONE NUMBER: q,2 7-9711
(Street) (City/state) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/state) (Zip)
X EACH c S 1
DESCRIPTION UNIT =AMOUNT \X'Q- 11101
SEWER CONNECTION X 50.00 = SO 4 4 6 Lf -3 L'\\
i
PLUMBING ALTERATIONS X 35.00 = 1 ' ( ve Si�\
SUBTOTAL $ velJ
EQUALS: TOTAL L-' ) \ 'P '�
PEMIT FEE DUE =$
SIGNATURE Gat.LCa ya-ck..-
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675