1992, 09-18 Permit App: 92007833 Sewer SEWER/PLUFING PERMIT APPLICATIOLe=ORM
INFORMATION WORKSHEET tie.A.A.G --
JOB STREET ADDRESS: E. 12sl l -
CITY/STATE/ZIP: 5(aekc.nt PARCEL NUMBER: LS �- 7 �• 047
MAILING ADDRESS: S - e
OWNER: Puri, PHONE PHONE NUMBER: c ps- 4((a'{a
(Street) (City/state) (Zip)
CONTRACTOR: H £ S CoNS72UCTroKt LICENSE NUMBER: HSCON•al',lc Ia3KF
PHONE NUMBER: °I26-89/04
MAILING ADDRESS: E 1/8/7 VALLEY14J0 AVE SPOk$ NE WA 99000
(Street) (City/state) (Zip)
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00 = So—
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