1994, 10-21 Permit App: 94010502 Sewer 01/03/1992 18:5981 509-9284306 ( RON SLOAN T43 PAGE 018 .w[
o
(A„(1 i J P 1 L 2 RiEWER CONNECTION PERMIT APPLICATION FORM `/050Z
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS NTIRETY AND
SIGNED OR PERMIT WILL NOT BE ISSUED.
' (IF IQIOWN)
JOB ADDRESS: L.. PARCEL NUMBER:
CITY: STATE: 14/.4- ZIPCODE: 9920
OWNER NAME: 5;;:g-71v1( 610161-44/ ADDRESS:
CITY: ,5:,/>c�-4 0^4- STATE: bk-ICA ZIP CODE:
PHONE NUMBER: Z 2= rSa C_) -
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES
(CIRCLE * .E
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
CONTRACTOR:. Milia l6S Ac ive ADDRESS: 6,(1ti 1L.L4 2
CITY: STATE: iAJ r ZIP CODE: q4 .1u-
PHONE NUMBER: 42.1- 435A0
STATE CONTRACTORS LICENSE NUMBER: A L gni AO/A 104, f 5
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES CD (CIRCLE ONE)
INTERIOR ALTERATION BY:
ADDRESS: PHONE NUMBER:
CITY: .. iU �,-/V STATE: 4 "'ZIP CODE: 9r/e / V
-._..moo
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP', GARAGE, ETC. THAT WILL
BE CONNECTED TO THE SEWER.
SEWER CONNECTION • # OF BUILDINGS X 50.00 mcw
INTERIOR PLUMBING ALTERATIONS:# OF BUILDINGS X 35.00 mg
TOTAL PERMIT FEE DUE $ t-C,
APPLICANT b f ySIGNATURE: DATE:
SPOKANE COUNTY:DEPT.. OF BUILDINGS
WEST 1024 .SROADWArAVBNUM' -- C.. ,4 / 2L-
SPOKANE,llA 99260 -