1992, 10-14 Permit App: 92008619 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM `f /`'3 b
INFORMATION WORKSHEET
fi /
C AV ) I �- I �`
JOB STREET ADDRESS:
7 ��/
CITY/STATE/ZIP: 1 ct 6;1 PARCEL NUMBER: 9; "
OWNER: 6",-/ `�e'r PHONE NUMBER:
MAILING ADDRESS: Cit /state) (Zip)
(Street) ( y
CONTRACTOR: ALw4'I5 AC-rig E LICENSE NUMBER: rt W A /4-410(oP5
PHONE NUMBER.
MAILING ADDRESS: ice- -yoY. /4t5ba S,PokANE WA 99a I4
(Street) (City/state) (Zip)
X EACH
DESCRIPTION
UNIT =AMOUNT
SEWER CONNECTION X 50.00 =
PLUMBING ALTERATIONS X 35.00 =
SUBTOTAL
EQUALS: TOTAL
.d
PEMIT FEE DUE =$ 50
I
SIGNATURE A
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675