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1993, 04-06 Permit App: 93002183 Sewer
3- D-3 SEWER/PLUMBING PERMIT APPLICATION FORM 3�� ���� INFORMATION WORKSHEET JOB STREET ADDRESS: /5‘/K K` F / 74 2 / 5 7 CITY/STATE/ZIP: S,d%%t 0-267 ��Z` ' PARCEL NUMBER: ,�// OWNERGv LJ /.ei PHONE NUMBER: ' 3 - 07lg7 MAILING ADDRESS: rr l.�(L . - < i s-,/ ‹` ag ����' (Street) (City/state) (Zip) CONTRACTOR: ci(� LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (( (Street) (City/state) (Zip) 5K X EACH U DESCRIPTION UNIT =AMOUNT ��(� SEWER CONNECTION X 50.00 = -5---&� -� ‘62-9` PLUMBING ALTERATIONS X 35.00 = ��a SUBTOTAL $ VC QUALS: TOTAL �I PEMMIT FEE DUE =$ SIGNATURE : f-r----- ,7okane County Department of Buildings West 1303 Broadway Avenue Spokane,WA 99260(509)456-3675