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1992, 11-24 Permit App 92010344 Sewer
SEWER/PLUMLAG PERMIT APPLICATION JRM INFORMATION WORKSHEET JOB STREET ADDRESS: •'Arc. / CITY/STATE/ZIP: OWNER: //4„,rd PHONE NUMBER: — 22 MAILING ADDRESS: _5' _i '2, (Street) (City/state) (Zip) CONTRACTOR: 9 „„ 944 r, r4c. LICENSE NUMBER 4 2 4 /2 /r (-4 1) — PHONE NUMBER: - f-A74 -- cr;Y MAILING ADDRESS: Al c rc4 ' /Id , 4 „rdd „ (Zip) PARCEL NUMBER: (Street) (City/state) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE :7-) X EACH UNIT X 50.00 = X 35.00 = SUBTOTAL EQUALS: TOTAL PEMIT FEE DUE / Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675 =AMOUNT =$