1992, 10-27 Permit App: 92009409 Sewerr
SEWER/PLUMBING PERMIT APPLICATION FORM op ��I
INFORMATION vVORKSHEET � dcj
a �
JOB STREET ADDRESS: a�c>`;, Col►, '
CITY/STATE/ZIP: ?C_r�2, PARCEL NUMBER:
MAILING ADDRESS: Lt.
OWNER: -)L&4,..,- tcncP PHONE NUMBER:
(Street) (City/state) (Zip)
CONTRACTOR: H f S Guns{-rLLcl-ton LICENSE NUMBER: f-{SCfliJ I '- t 7.V K
PHONE NUMBER: ct 2.(D- MaL1_
MAILING ADDRESS: a. I lal UAu..Ey d PIUS. SPdKAk)c., !,c1 A. (9Zd(o
(Street) I (City/state) (Zip)
XEACH c ( C
DESCRIPTION UNIT =AMOUNT
SEWER CONNECTION X 50.00 =
PLUMBING ALTERATIONS X 35.00 =
SUBTOTAL $
EQUALS: TOTAL
PEMIT FEE DUE _$
i?SIGNATURE
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675