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1992, 09-16 Permit App: 92007690 Sewer
SEWER/PLUMBING PERMIT APPLICATION FORM / ,/ _ INFORMATION WORKSHEET ( 'N ZA_? / • JOB STREET ADDRES : - . 1�� c'�-7 / I(--`- U CITY/STATE/ZIP: r c-�.,c' • PARCEL NUMBER: - — c'2.- 1Z4 , MAILING ADDRESS: .,S ...y> - ----,- OWNER: /1-2�-- 6'--? , PHONE NUMBER: "- _�J,.3 9a---1 'cl:u (Street) (City/state) (Zip) CONTRACTOR:CotaeatiMNE EXCAvpin Da LICENSE NUMBER: COLA EcCak. -8-t t✓7 Up, 1(1QICk` PHONE NUMBER: cla4-5485 MAILING ADDRESS: E. if24C,? UAILEYw y AVE Ve-P DA-Le L4/,4- ' O7 (Street) (City/state) (Zip) /1 X EACH \MI'Cji \ DESCRIPTION UNIT =AMOUNT SEWER CONNECTION X 50.00 = %.,`-4/ a-c' PLUMBING ALTERATIONS X 35.00 = -�- c' SUBTOTAL $. " -' 0 EQUALS: TOTAL r A-ee. PEMIT FEE DUE _$ '• • - . 'i 6./` L'�%-G , SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675