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1992, 09-15 Permit App: 92007657 Sewer
/) SEWER/PLUMBING PERMIT APP LICATION FORMS • INFORMATION WIORK&HEET ' ` 1�� JOB STREET ADDRESS: S.,6.77 CITY/STATE/ZIP: Spa %9 i MAILING ADDRESS: 31-1n-, CONTRACTOR: MAILING ADDRESS: DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE (Street) (Street) PARCEL NUMBER: 443‘,27.3 c7/3 /gnu[ AAP,7i4!4✓ 13 dl wit"/:! -rot 17in1 LICENSE NUMBER: PHONE NUMBER: s--_,.? i S— ..57:7Y (Ci y/state) X EACH UNIT X 50.00 = X 35.00 = SUBTOTAL EQUALS: TOTAL PEMIT FEE DUE (Zip) =AMOUNT Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 '/\cCe