1993, 12-21 Permit App: 93010275 Sewer �452gI .l tet-ta•
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• SEWER/PLUMBING PERMIT APPLICATION FORM
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►. C. INFORMATION WORKSHEET g3 6/ ( I 1(
Alluo,k. '93 Ls
JOB STREET A KESS: E /2 Z� 1 Z�rr`
CITY/STATE/ZIP: C2-O ( PARCEL NUMBER:
MAILING ADDRESS: _C4-74 E
OWNER: /"II MG f PHONE NUMBER:
(Street) (City/state) (Zip)
CONTRACTOR: A LLAJ101 S ACTIVE LICENSE NUMBER: A LI4AY R 95
PHONE NUMBER: 9aa-8500
MAILING ADDRESS: '.O• -6o.k 1 LI I 56 POkAnic WA c19a.1y
(Street) (City/state) (Zip)
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00 = _CO
PLUMBING ALTERATIONS X 35.00=
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE =$ .0
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675