1992, 06-08 Permit App: 92004103 Sewer SEWER/PLUMBING PERMIT APPLICATION FORM
INFORMATION WORKSHEET
JOB STREET ADDRESS: E. /07/‘ •2 6
CITY/STATE/ZIP: 5fioihw4 GIA 99206 PARCEL NUMBER:
OWNER: T etas ...‹Cheicc..PAR PHONE NUMBER: (co,) 9'2 /s o 8
MAILING ADDRESS: E. /07/6 28 . ;e0/cRN1, C)4. 99zol
(Street) (City/state) (Zip)
CONTRACTOR: I9NR r f41401O/w G LICENSE NUMBER:
PHONE NUMBER: 2
MAILING ADDRESS:
(Street) (City/state) (Zip)
X EACH `ti)
DESCRIPTION UNIT =AMOUNT C.r°
SEWER CONNECTION X 50.00=
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