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1992, 07-10 Permit App: 92005138 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM th- INFORMATION WORKSHEET JOB STREET ADDRESS: £ Cie:/ — - - PARCEL NUMBER: `t pMIER ( " ,/1 L%' PHONE NUMBER: %7`t-, MAILING ADDRESS: (Street) (City/state) (Zip) CONTRACTOR:COueCHA-INE EXCAVA'T►oN LICENSE NUMBER: COU eCQ )Li 9 t£ 7 PHONE NUMBER: q a'/-5485 MAILING ADDRESS: E . !4L4O UA-U-E*WA`( AVE V`eeAtALE vJA c29037 (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00= PLUMBING ALTERATIONS X 35.00= SUBTOTAL $ E` EQUALS: TOTAL PEMIT FEE DUE • SIGNATURE r _G� � - Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675