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1992, 07-02 Permit App: 92004943 Plumbing Reversal
SEWER/PLUMBING PF,rRISIT APPLICATION FORM ...-INFORMATION WORKSHEET JOB STREET ADDRE S - 70 9 eta_ - CITY/STATE/ZIP PARCEL NUMBER: /� OWNER: ) PHONE NUMBER: �/ia! -7— /r0 �6`9 MAILING ADDRESS: (Street) (Citylstate) (Zip) CONTRACTOR: COUCCHAIME EYCAVATIDN LICENSE NUMBER: COU eee #.S B1 e9 PHONE NUMBER: CI a4.5985 MAILING ADDRESS: E. Ilc402 UAuegL4AY AVB VEeANALE WA 99037 (Street) (Citylstate) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE _ClOe Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 X EACH UNIT =AMOUNT X50.00= g F_t X 35.00 = v. -7S- o-0 SUBTOTAL $ 2)'S EQUALS: TOTAL PEMIT FEE DUE =$ 0.�6_ep yVa 9SC