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1992, 07-10 Permit App: 92005139 Plumbing Reversal • SEWER/PLUMBING PERMIT APPLICATION FORM NF RMATION WORKSHEET JOB STREET ADDRESS: ' CITY/STATE/ZIP> )C%_ (Te - PARCEL NUMBER: OWNER: /(IP ' a' 1 a PHONE NUMBER: 7 --45-0 0 MAILING ADDRESS: (Street) (City/state) (Zip) CONTRACTOR:COUECt dME ECA ATIoN LICENSE NUMBER: CDU ecc' 18Z e`I PHONE NUMBER: qa4-5'485 MAILING ADDRESS: E . (pyba UA-u.E /WA'f AVe YeeAfALE WA ci9037 (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00 = PLUMBING ALTERATIONS X 35.00 = SUBTOTAL $ <LT EQUALS: TOTAL c)-.e) PEMIT FEE DUE _$ 7 SIGNATURE 4.0 f..��.-, Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675