1992, 12-14 Permit App: 92010900 Plumbing Reversal SEWER/PLUMBING PERMIT APPLICATION FORM 9 3- /01D7
INFORMATION WORKSHEET
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JOB STREET ADDR SS: C - -2-9(D - 2-60f L
CITY/STATE/ZIP: �kc.paa , (Airs PARCEL NUMBER:
MAILING ADDRESS: S1 L-.C.
OWNER: -31e R4.,-/t J PHONE NUMBER: q Z-Z'Z S s
(Street) (City/state) (Zip)
CONTRACTOR: H £ S epNS7)21.UCTiolt LICENSE NUMBER: HSCON ,IE Ia3KF
PHONE NUMBER: 926-89(04 A
MAILING ADDRESS: E /1817 1lAUzYkitY AVE 3PokfrNE WA 99a0(0
(Street) (City/state) Pp)
X EACH
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00=
PLUMBING ALTERATIONS X 35.00= 3 c --
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE =$ 3S-
SIGNATURE �� -_
_r •• ane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260(509)456-3675