1989, 07-17 Permit App: 89002254 Sewer Reversald
PLUMBING PERMIT APPLICATION FORM
I Information Worksheet
JOB STREET ADDRESS: 1 3 O i 1qI J) (S l'ey JJ�� /lT I/r�
CITY/STATE/ZIP: PARCEL NUMBER: C� �T� - ( (5
OWNER: ert eq G h 7 3 P PHONE NUMBER: 90E) Mel
MAILING ADDRESS: I2 Mc! %.-s P—
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER: dg y C %7
'// //j PHONE NUMBER: 72 ci k)
MAILING ADDRESS:t: � �j S i' Vi;! jetlJa-y l/447¢cc'stair 99.h"
(Street) / (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
NUMBER OF
FIXTURES
X EACH
FIXTURE
= AMOUNT
TOILETS
SINKS
SHOWERS
BATH TUBS
KITCHEN SINKS
DISH WASHERS
GARBAGE DISPOSAL
CLOTHES WASHER
UTILITY SINKS
ELECTRIC WATER HEATERS
FLOOR DRAINS
FLOOR SINKS
BAR SINKS
ROOF DRAINS e.,-�a�-A icetV
SEWN EPRINKLER nn
_SEWAGE—EJECTOR"�J i dsL -�
WATER SOFTENER
URINAL
DRINKING FOUNTAIN
x $6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
x 6.00
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
$ 'a>. (D?,)
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
West 1303kBroadway Menne Spokane, WAS 99260 Safety 09) 456-3675