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1992, 11-03 Permit App: 92009520 Sewer
SEWER/PLUMBING PERIAITAPPLICATION FORM Sao INFORMATION WORKSHEET CG /� ,c j 9.- JOB STREET ADDRESS: - /` 49, CITY/STATE/ZIP A�� - •G PARCEL NUMBER: OWNER: 4ll3/-- ?Q- ) PHONE NUMBER: � �-7 MAILING ADDRESS: ' "' -YC-----e----- (Street) Y`�(Street) (City/state) (Zip) CONTRACTOR: COUMHANE e CAYhflON LICENSE NUMBER: Coueccak1.8$e.1 PHONE NUMBER: CW4"5y85 MAILING ADDRESS: E. 10402.. VAt.UEyt)q't AYE V'c-2acALE wA- 94037 (Street) (City/state) (Zip) Sk X EACH J���C'C�� '��� DESCRIPTION UNIT =AMOUNT v CONNECTION X 50.00 = c` Z) 2 �C � W.f. .f. ISEWER L PLUMBING ALTERATIONS X 35.00= \)E� a SUBTOTAL $ _2_,... --. EQUALS: TOTAL l L PEMIT FEE DUE _$ �0 l., - ' 0 SIGNATURE / - /-- _i .e-�� Spokane County Department of Buildings West 1303 Broadway Avenue Spokane,WA 99260(509)456-3675