Loading...
1993, 11-16 Permit App 93011194 Sewer' 3<5 -/c 32- SEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT BE ISSUED. ( IF KNOWN ) JOB PARCEL NUMBER : rsP4-4 • I gl ) OWNER NAME: CITY: n STATE: ZIP CODE: �i'«)(/,‘ 4)v-e_ ADDRESS: STATE: PHONE: 9,71 PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES d�0� (CIRCLE ONE) *IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT THE .UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUER. CONTRACTOR: 1-A S CO R-S+(1.1 C.Air)C ADDRESS: 1 S 11 Va.l 1,_p Af (j�(/ CITY: -6{Jp]�Gllie, STATE: 14A PHONE: SoG - C126. Y�L'1-�- ` aG20(c, STATE CONTRACTORS LICENSE NUMBER..: 145 LC I\! 1Z3 K UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES (CIRCLE ONE) INTERIOR ALTERATION WORK BY..: ADDRESS: PHONE: CITY: STATE: ZIP CODE: *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION : ## OF BUILDINGS X 50.00 = 5/./ INTERIOR PLUMBING ALTERATIONS: ## OF BUILDINGS X 35.00 = 00 TOTAL PERMIT FEE DUE $ APPLICANT SIGNATURE /l SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675