1992, 10-29 Permit App: 92009525 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM
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INFORMATION W:ORKS'HEET C '�- - CJ
JOB STREET ADDRESS: - /z a o `" /-9-6,----
CITY/STATE/ZIP: -1 - (�J) - PARCEL NUMBER: - 0\a _95a5
OWNER: <7 / -� e__ee__, PHONE NUMBER: c� 95S
J c\54-\
MAILING ADDRESS:
(Street) (City/state) (Zip)
CONTRACTOR: Q_JA.121.HAINC E IVIkt10N LICENSE NUMBER: COU.CC*i8 i i
PHONE NUMBER: gall -5485
MAILING ADDRESS: E. i(DUOa VALLEYWPty Pots VEQADALE WA X1037
(Street) (City/state) (Zip)
5-(
X EACH G
DESCRIPTION UNIT =AMOUNT Gi
SEWER CONNECTION X 50.00= :57D `¢ '
PLUMBING ALTERATIONS X 35.00= ,....... i
SUBTOTAL $ 9-f
EQUALS: TOTAL �_
PEMIT FEE DUE _$
40
SIGNATURE r (Si'-ee.-- C .._,j,--e----Z,e--2...__,
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675