1992, 09-16 Permit App: 92007675 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM .
INFORMATION WORKSHEET L%i-7/C2. C�
Y
JOB STREET ADDRESS: l18oy ET A -ke:S----1:
/ /�
CITY/STATE/ZIP: �,)erc,ac,fe, we, PARCEL NUMBER: f (,c, `1
MAILING ADDRESS: 4
OWNER: Ken PSt{erSur, PHONE NUMBER: i 2,c,-c,9 c
(Street) (City/state) (Zip) 'CIS
CONTRACTOR: H E S ►aoN5T2UCTroN( LICENSE NUMBER: HSCON14,f Ia3K
PHONE NUMBER: cI26'89fA B
MAILING ADDRESS: 11817 VALLEWt1 `I AVE SPO k+cntE WA g9000
(Street) (City/state) (Zip)
X EACH 0
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00 = :;
PLUMBING ALTERATIONS X 35.00 = 1C
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE _$ '
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675