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1992, 12-09 Permit App: 92010806 Plumbing Reversal
SEWER/PLUMBING PERMIT-APPLICATION FORM, �� INFORMATION WORKSHEET JOB STREET ADDRESS: /' ( n..g /5 �- CITY/STATE/ZIP� �' - PARCEL NUMBER: "T^ OWNER: �6----2 ��-_-,e-7, PHONE NUMBER: %,0V 1- MAILING ADDRESS: (Street) (City /state)/state) (ZiP) CONTRACTOR: Q.LUEHAINE EXCAVATION LICENSE NUMBER: COU Cc 81-�� PHONE NUMBER: MAILING ADDRESS: E• t(DUU. VALLEyWPty P`is veekbALE WA m037 (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 _$ �- e�1 SIGNATURE tO - «�`- "'`-e----) Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675