1992, 10-01 Permit App: 92008294 Sewer SEWER/PLUMBING PcRMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS: �• Iysio 16-74 Avg
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER:J 1 m RA-53 .7PHONE NUMBER:
MAILING ADDRESS: S rMLii-ii-s-- - iTpp,,�
�
n (Street) (City/state) (Zip)
CONTRACTOR: Pg.°- 016 LICENSE NUMBER: Pe o o-zG9`1 J a
PHONE NUMBER: 9,21 (56 1 SMAILING ADDRESS: i', 0- £OiC 3029 V i 4(4- t fi ). 9903'7
(Street) (City/state) (Zip)
XEACH � � 2
,
DESCRIPTION UNIT =AMOUNT ,�� �-
ISEWER CONNECTION X 50.00 =
[PLUMBING ALTERATIONS X 35.00 =
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE =$
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675