1992, 10-06 Permit App: 92008465 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM {j
INFORMATION WORKSHEET
JOB STREET ADDRESS: lig 11 " LO
CITY/STATE/ZIP:`�I� 2c)a 99837PARCEL NU BER:
MAILING AD RESS: Er'//-7/-8/I /S'�- 2�Qh�h 2lJcr� q63 7 t/4
OWNER: ; .,.t�J> +3a PHONE NUMBER: ?ae.
(Street) (City/state) (Zip) k z/
CONTRACTOR: L F LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS: --S)971//(/ --
(Street) (City/state) (Zip)
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00 =
PLUMBING ALTERATIONS X 35.00 =
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE =$
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675