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1992, 09-14 Permit App: 92007541 Sewer
/ _. 5 - �otP SEWER/PLUMBING PERMIT APPLICATION FORM �� INFORMATION WORKSHEET `�� 2 //99/' q2 --)94 D-- JOB STREET ADDRESS:``�- /, $!& CITY/STATE/ZIP: c�7 a/ PARCEL NUMBER: CA:)-: OWNER:d-/ 4ir At o be,1' PHONE NUMBER: �0. /'' O! z// MAILING A60/KESS: _c-c--..- (Street) (City/state) (Zip) CONTRACTOR: 14 SCONS TgUCTION LICENSE NUMBER: HSCOnf-**t23KF PHONE NUMBER: q 2fo-8q(D q MAILING ADDRESS: C.. 118I1 UAu.E'U)Ai AVE SPOk.ANE WA glctOOlo (Street) (City/state) (Zip) X EACH �GI �lk� DESCRIPTION UNIT =A OUNT j( SEWER CONNECTION X 50.00= V i ‘4 PLUMBING ALTERATIONS X 35.00= SUBTOTAL $ \XS pie EQUALS: TOTAL )1 _d Ju PENT FEE DUE _$ . y5 SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675