1992, 08-04 Permit App 92005776 SewerJOB STREET ADDRESS: J ��(% j'�, c l a rJ
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: d f'‹- /v/;C' PHONE NUMBER: r ,,;2'
SEWER/PLUMBING PERMIT APPLICATION FORM C3 --j�
INFORMATION WORKSHEET /(Q `� 1ws� ,moo` -a. a��
/ / ✓ dv
MAILING ADDRES€
Pipet) (Citylstate) (Zip)
CONTRACTOR:/V C-,.ryJ,/ LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street)
(Citylstate)
DESCRIPTION
SEWER CONNECTION
PLUMBING ALTERATIONS
SIGNATURE;
X EACH
UNIT
AMOUNT
X50.00=
X 35.00 =
\,
SUBTOTAL
$
EQUALS: TOTAL
,MIT,f EE DUE
=$
6''S
u
CEIVED
JUL 23 1992
.iUiLDING is SAFETY
\eb4%O L5(S .o(ol
Z-- I ( Q ^"1
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675
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