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1993, 07-12 Permit App: 93005699 Sewer
Zofr 1�5 -5L �1 SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET 1-4; _ .,het �LAScA JOBSTREET ADDRESS: CITY/STATE/ZIP: __ ___._. PARCEL NUMBER:___ . MAILING ADDRESS' �.�(Streetl (Gityisiate) (Z._i_p._-) CONTRACTOR:�LICENSE 1Bt! PHONE_ NUMBER: -----____-- MAILING ADDRESS--t_J _l._j X--�A_ M_ _a1L Za . _ ._ �,%� 00— (Street) (City/state) (Zip) ;X EACH DESCRIPTION UNIT `-AMOUNT 'SEWER CONNECTION (PLUMBING ALTERATIONS X 35.00 = 1 SUBTOTAL - ... -- E01_IALS: TOTAL. PEMIT FEE DUE =$ SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675