Loading...
1994, 08-08 Permit App 94007570 Plumb ReversalSEWER CONNECTION PERMIT APPLICATION FORM *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY AND SIGNED OR PERMIT WILL NOT BE ISSUED. // (IF KNOWN) JOB ADDRESS : C� / f, Ozz: / v F. C/ 74- PARCEL NUMBER: 5C ,Z /,O .l/ % O CITY: �d/�A// C . STATE: 6r/�, . ZIP CODE: 72/�0‘ OWNER NAME: i6r��F 2. rl/F_/ An 244/ ADDRESS: .-0/ 2©17 (/�/) u/ehS7 �ij CITY: J fJn/�/j �i �, STATE:o , ZIP CODE: / 2-� (1 (e PHONE NUMBER: ?Q -- \S 5 /( PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? kuIRCLE ONE) *IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUUED. CONTRACTOR: J / / PA ( 7/94) �li,37 ADDRESS: c 57 6/2-1 U err/17 CITY: cc/Jr'STATE: 2"-1 ZIP CODE: 2 2-2OC� PHONE NUMBER: ?Ord' ‘. 7:7711-7 STATE CONTRACTORS LICENSE NUMBER: CC / /O r UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? NO (CIRCLE ONE) INTERIOR ALTERATION BY: ADDRESS: PHONE NUMBER: /Z/�-sSS /C% CITY: STATE: ZIP CODE: *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION '# OF BUILDINGS X 50.00 = INTERIOR PLUMBING ALTERATIONS:# OF BUILDINGS X 35.00 = TOTAL PERMIT FEE DUE $ APPLICANT SIGNATURE: / „ .P�j d . d DATE: -C/ SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675