1994, 09-27 Permit App 94009463 Sewer4"! 11,1iii,irIII III fi
;. I I
, I' SEWER CONNECTION PERMIT APPLICATION FORM
M*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND
SIGNED OR PERMIT WILL NOT BE ISSUED.
i (IF KNOWN)
JOB ADDRESS: 523 S UniyQrsity PARCEL NUMBER:
CITY: Spokane
OWNER NAME: Andy Heesh
STATE: WA
ZIP CODE: 99206
ADDRESS: Same
CITY: STATE: ZIP CODE:
PHONE NUMBER: 5Oq/Pq1-9231
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO
(CIRCLE ONE)
*IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
Cr;I: I RACTOR : E(1r('S C-0 1.4-irlAe-430 1 ADDRESS : q '7 1 L , 441'1
CFI:: 1c)( .4{C>_.Fl� STATE: V(1A ZIP CODE:_ q 92.0(e,
PHONE NUMBER: 612.'-4- - , 132,
STATE CONTRACTORS LICENSE NUMBER:
EQ,LSC.G4GL4G5
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE)
IN'1' RIOR ALTERATION BY:
!I)UI:E:;S: 1.'flO111•; 1111MH1•;11:
CITY:
STATE: 'I, 1. P CODE:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL
I3E CONNECTED TO THE SEWER.
SEWER CONNECTION • # OF BUILDINGS X 50.00 S'D.op
INTERIOR PLUMBING ALTERATIONS:# OF BUILDINGS X 35.00 =
TOTAL PERMIT FEE DUE $ 50.00
APPLICANT
SIGNATURE: DATE: j� -4L
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675