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1989, 08-16 Permit App: 89002835 Plumbing FixturesPLUMBING PERMIT APPLICATION FORM information Worksheet JOB STREET ADDRESS: C"-- 300 2— ,f ) 0 s c e t, CITY/STATE/ZIP: 500 (441, aIASS,2 / 6- PARCEL NUMBER:/n2225-4/ -ISO,/ OWNER: /4 • A )ie A ,La / S PHONE NUMBER: 90 -zi- '% c0 MAILING ADDRESS: 6- AA(v)2_ (Street) A(v)2- (Street) CONTRACTOR: ,cp (41 MAILING ADDRESS: AL cc (2 c;,006/(2,),/ A/4 9ii.,/( (pCity/State) (Zip) LICENSE NUMBER: PHONE NUMBER: (Street) (City/State) (Zip) NOTE: 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 LAWN SPRINKLER / 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 = ( / / SEWAGE E3 -€C WATER SOFTENER URINAL DRINKING FOUNTAIN MINIMUM PERMIT FEE IS $35.00 SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ SIGNATURE West 1303kBroadway AvenuertSpokane, Building_ Safety 456-3675