1993, 04-06 Permit App: 93002184 Sewer SEWER/PLUMBING PE: f IT APPLICATION FORM , (5� , L,\,INFO•-do, ON WORKSHEET GI 3 �\
JOB STREET ADDRESS: 41 6 0 P . / r
CITY/STATE/ZIP: c1 ./&) PARCEL NUMBER: i 011e sal 't��
OWNER: "dile PHONE NUMBER: e;�
MAILING ADDRESS: 5 (Cit /state
(Street) (City/state) (Zip)
CONTRACTOR: ALLO 'I5 ACTIVE LICENSE NUMBER: �flaa�5�10(oP5
PHONE NUMBER:
MAILING ADDRESS: sP°. xO)L )415b a S4O kA N£ WA. q9a 14
(Street) (City/state) (Zip)
X EACH cre s�
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DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION E !�'''
PLUMBING ALTERATION %� E'.0O= $
If 1 EQUALS: TOTAL0 '�
lit ° PEMIT FEE DUE =$
SIGNATURE A -
Spokane County Department of Buildings
1,.,.,,,a..,n., wGn"P Snnkane. WA 99260 (5091456-3675