1993, 04-15 Permit App: 93002500 Sewer SEWER/PLUMBING PERMIT APPLICATION FORMc�
INFORMATION WORKS ET 0; 7,
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JOB STREET ADDRESS: / Yr/K Pr,./ C)
CITY/STATE/ZIP: PARCEL NUMBER:
MAILING ADDRESS:
OWNER: � PHONE NUMBER: 9'22g',z7
St -et . (City/state) (Zip)
CONTRACTOR:, i `�.��, LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:/? /-70X /2/2 P 2- -S a *', lfrl
(Street) (City/state) (Zip)
X EACH •
(<,��
UNIT =AMOUNT 1�C
DESCRIPTION ���1"� � cA
SEWER CONNECTION X 50.00 = `?- !'\ \- (���
PLUMBING ALTERATIONS X 35.00= 11
SUBTOTAL $ "C WeArf°,-
EQUALS: TOTAL r�I,`��
PEMIT FEE DUE =$ V L C]
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675