1992, 06-18 Permit App: 92004478 Sewer �z �
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SEWER/PLUMBING PERMIT APPLICATION FORM Loci,11
INFORMATION WORKSHEET
qrf/ a E 1 + h, . Vega. rk6 t,-9 , b " 5
JOB STREET ADDRESS.
CITY/STATE/ZIP:VLM9PNl c , w A. 9%37 PARCEL NUMBER: 4 5 2 3 Li. t 5,)_0
MAILING ADDRESS: ac -nso (Street) (City/state) (ZIP)
CONTRACTOR:
E L f LICENSE NUMBER: v e f21 - E s7
PHONE NUMBER: qd - 6 (:)- - 5' (��� L��� �} �
MAILING ADDRESS: PS Cit /state) (Zip)(Street) ( Y
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION iX 50.00 = 50. 00
PLUMBING ALTERATIONS i X 35.00= z , o b
SUBTOTAL $ cz S'. O 0
EQUALS: TOTAL ao
PEMIT FEE DUE =$
SIGNATURE (kn.._-P- Blvd Q .
U L P_ Etit J le$pokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675