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1989, 09-12 Permit App: 89003324 Plumbing FixturesJOB STREET ADDRESS: PLUMBING PERMIT APPLICATION FORM Information Worksheet LE. Fay eLle.kioye. CITY/STATE/ZIP: Spo 7cn te_.)c 99 2/ L PARCEL NUMBER: OWNER: 1? u \lYOO MAILING ADDRESS: ,t3/}111F= PHONE f}11 i PHONE NUMBER: C% a 8 q05 7 (Street) CONTRACTOR: MAILING ADDRESS: ..S /4 rn e= (City/State) (Zip) LICENSE NUMBER: PHONE NUMBER: 9 0, 7 6 J 7 (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 LAWN SPRINKLER SEWAGE EJECTOR 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 = lx 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 + $ 25.00 1 EQUALS: TOTAL PERMIT' FEE DUE I= $ I I I Spokane County Department of Buildin_q and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675