1993, 03-26 Permit App: 93001849 SewerSEWER/PLUMBING PERMIT APPLICATION
FORM
INFORMATION WORKSHEET
(`
JOB STREET ADDRESS: � ��>
CITY/STATE/ZIP: c,_
PARCEL NUMBER:
MAILING ADDRESS:
OWNER:
PHONE NUMBER:
(Street)
(City/state)
(Zip)
CONTRACTOR: -H i S CQN572UcT11D►.1
LICENSE NUMBER: 14SCON-46v1
Ia3K.F
/C7
PHONE NUMBER: 92(0-99404
v 1
MAILING ADDRESS: 5- 1t817 UALL-F-VAY
AVE SPOkoNE WA
990NO
O�
(Street)
(City/state)
(Zip)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
i
X EACH
UNIT =AMOUNT
X 50.00 = \
X 35.00 = �, V
SUBTOTAL $ v
EQUALS: TOTAL
PEMIT FEE DUE =$
SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675