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1993, 03-15 Permit App: 93001496 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM �� a /,I IAIORMATION WORS�J�ET OCCACa JOB STREET ADDRESS: / S--0- 2 e, /( �Fj/� oc)f CITY/STATE/ZIP: PARCEL NUMBER: MAILING `i j ,IrOWNER: PHONE NUMBER: / / Stree (City/state) (Zip) CONTRACTOR:X� - LICENSE NUMBER: PHONE NUMBER: 9, 2---6* MAILING ADDRESS: (Street) (City/state) (Zip) X EACH � DESCRIPTION UNIT =AMOUNT C(.&‘ Gj I SEWER CONNECTION X 50.00 = Vda qI PLUMBING ALTERATIONS X 35.00= �� (. SUBTOTAL $ a Q.v- (6 "' EQUALS: TOTAL 1. PEMIT FEE DUE =$ ‘\I �'� �A-6 l SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675