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1992, 09-04 Permit App: 92007280 Sewer
SEWER/PLUMBING PERM) U APPLICATION FOR INFORMATION WORKSHEET ((�� JOB STREET ADDRES : // _ 4-2 L( cp.S - �� y CITY/STATE/ZIP: k c, - L6 ! PARCEL NUMBER: `— q2,28/() MAILING ADDRESS: �5 ��- OWNER: "% rL PHONE NUMBER: ‘237,77---)---6' 7/ (Street) (City/state) (Zip) CONTRACTOR:CoUeetiWie EXCAVPmOry LICENSE NUMBER: COLI EcCAt1.81-7 PHONE NUMBER: claq-485 MAILING ADDRESS: E. Ib'itb? UALLEYWAV {AVE VeeADA"Ik WA- 89037 (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE 1/ Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 X EACH UNIT =AMOUNT X50.00=7) Oar' X 35.00 = SUBTOTAL $ c" EQUALS: TOTAL PEMIT FEE DUE =$ 'Se) ,