1993, 05-06 Permit App 93003271 Sewage Ejector-VoidT AP
N FORM
*THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY
AND SIGNED OR PERMIT WILL NOT BE ISSUED.
JOB ADDRESS: E. )Llla3 &?0 Adu» /
(IF KNOWN)
PARCEL NUMBER:
CITY:.SPvFVE- STATE: WAI- ZIP CODE: 9`7,2/4
OWNER NAME: /C2RC7/ L- es/'°y"YJ
STATE: WPHONE: 9a^FD024-
CITY: 6-,90k/i�
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? NO
(CIRCLE ONE)
ADDRESS: E;/4//a3 B,evrnita
*IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUEQ..
CONTRACTOR: ADDRESS:
CITY: STATE: PHONE:
STATE CONTRACTORS LICENSE NUMBER..:
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS?
SSA- (vE Jcc -oe
NO (CIRCLE ONE)
INTERIOR ALTERATION WORK BY..: Tej ey 4. bJeckR/� ,p
ADDRESS: 2 . %L//23 %3,�b .aa-GJA-y PHONE: �Iv- ‘ - d7DR4
CITY: S)- /0k4/1/ STATE: L--4 - ZIP CODE: 9y�/6
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC
THAT WILL BE CONNECTED TO THE SEWER.
SEWER CONNECTION # OF BUILDINGS X
INTERIOR PLUMBING ALTERATIONS: # OF BUILDINGS X 35.00 = 39_0-o
TOTAL PERMIT FEE DUE $ 465- CgC:15
APPLICANT
SIGNATURE/XJ%-i
/
SPOKANEtiOUNTYDEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675