1993 01-19 Permit App: 93000242 Plumbing FixturesPLUMBING PERMIT APPLICATION FORM 9 Le2
Information Worksheet
JOB STREET ADDRESS: //O/ S, j 4 �, i j4' i � �X I2 Lco
CITY/STATE/ZIP: IA) ,a ¶*,4/ /UJ PARCEL NUMBER:
A4,44 c
OWNER: J btJC-: rZouuAJ/' PHONE NUMBER: vZ 74-(oZl � og -�/-20-94968-Wonk
MAILING ADDRESS: elk-)? 003 S �Ivn.4- g—LQ D-e-ert- 2912-K 1,0-J 7g006
(Street) (City/State) (Zip)
CONTRACTOR: S -e / E LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Zip)
(Street) (City/State)
DESCRIPTION
TOILETS
SINKS "
SHOWERS
BATH TUBS;
KITCHEN SINKS
DISH WA51-1ERS
GARBAGE DISPOSAL
CLOTHES WASHER
UTILITY SINKS
ELECTRIG;WATcam
E
FLOOR DRAINS
PLUMBING WORKSHEET/FEE SCHEDULE
BAR SINKS
ROOF_DRA.INS
LAWN SPRINKLER - FOR EACH BACKFLOW
SEWAGE EJECTOR':;
WATER SOFTENER
UitliTtjklAtpr.
DRINKING FOUNTAIN
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 6.00 =
x6.00 =
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 =
x6.00=
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
6, 60
J
‘.00
SUBTOTAL
$ / 1 00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
3760
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675