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1993, 03-12 Permit App: 93001457 Sewer
SEWER/PLUMBING PERMIT APP1ICATION FORM INFORMATION WORKSHEET -17C‘ JOB STREET ADDRESS: /3/0,3'66'. /e-74- CITY/STATE/ZIP: -CITY/STATE/ZIP: .Sy,p /71.47, PARCEL NUMBER: i- t2? k\►� jtvl� MAILING ADDRESS: OWNER: flfr %�- Ly A. GTPA) PHONE NUMBER: 9��- 9/0 r�� //4Street (City/state) (Zip) CONTRACTOR: ` -Z G . l,oivcsr LICENSE NUMBER: PHONE NIJ,MBER: 9 0 MAILING ADDRESS: /3e1% E /2 h?, n/SArA/E LAM- . 9-2 l (Street) (City/state) (Zip) X EACH DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00= 5D, 0 0 PLUMBING ALTERATIONS X 35.00 = SUBTOTAL $ EQUALS: TOTAL PEMIT FEE DUE =$sa, 0 0 SIGNATURE✓�/. ►. 4-� Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675