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1993, 04-01 Permit App: 93002022 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET M JOB STREET ADDRESS: / ?/67 Zi / CITY/STATE/ZIP: PARCEL NUMBER: MAILING ESS: � . :t4- OWNER: /f 8�-1- c i—}_ PHONE NUMBER: ` (Str et) �j (City/state) (Zip) 1, ! CONTRACTORz ��D�-t LICENSE NUMBER: Pa� PHONE NUMBER: 92g--zS�_S 7 (�` ' 64> MAILING ADDRESS: \-�✓ (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00= PLUMBING ALTERATIONS X 35.00 = \ 1 °C)tffl �G SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$ SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675