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Home My WebLink About1992, 09-30 Permit App 92008254 Dry Line SewerSEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS: /,/jeA . c6Gt.tJiri q-15- CITY/STATE/ZIP: -- k�'�' Lei PARCEL NUMBER: /�. 9 _. - 9/ Z _ %G('q 1 MAILING ADDRESS: (Street) CONTRACTOR: Pisit- �a!,�'rz (City/state) (Zip) LICENSE NUMBER: /r4L�.//O- !b PHONE NUMBER: MAILING ADDRESS: /4_1.2 o 3,7-3ri&c Q (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE X EACH UNIT =AMOUNT X 50.00 = -Si-5 X 35.00 = SUBTOTAL $ c---d EQUALS: TOTAL PEMIT FEE DUE =$ 5-6 — Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 992 ' 56-3675 /ODD