1992, 04-06 Permit App: 92002212 Plumbing FixturesPLUMBING PEF?MII'APPLICATION FORM
S. Informations Worksheet
JOB STREET ADDRESS: o 3 EL4i ` e
CITY/STATE/ZIP: 1/45freb« 604 • PARCEL NUMBER:
OWNER: M•L . MAn/A/
MAILING ADDRESS:
CONTRACTOR:
�aaa�a
(43
PHONE NUMBER: 7�6 _ 38./C)
DwAJ
(Street)
MAILING ADDRESS:
4z5 ;t -i vim,
(City/State)
LICENSE NUMBER:
PHONE NUMBER.
(Zi p)
(Street) (City/State)
(Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
TOILETS
'SINKS
SHOWERS
BATH was -
KITCHEN SINKS
DISH WASHERS:
GARBAGE DISPOSAL
CLOTHES WASHER-
UTILITY SINKS
ELECTRIC WATER HEATERS_
FLOOR DRAINS
:FLOOR SINKS
BAR SINKS
ROOF DRAMS
LAWN SPRINKLER
SEWAGE EJECTOR
WATER SOFTENER
URINAL
•
DRINKING FOUNTAIN
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
C4
1
Co
SUBTOTAL
S / D....00
PLUS: PROCESSING FEE
+ S 25.00
EQUALS: TOTAL PERMIT
FEE DUE
l
= S 39, lib
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675