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1992, 11-03 Permit App: 92009711 Plumbing Fixtures
Alb PLUMBING PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: E 7 ' 0 2 `N L. I<".z'I € CITY/STATE/ZIP: PARCEL NUMBER: OWNER: DGI\{ A PAL .7C n1\%' A PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: S A14 -R9 c' LICENSE NUMBER: $ 6'S 4 UPC C r e 4 C `; n PHONE NUMBER: 461- g��jj MAILING ADDRESS: fi, 76 c' / " ` i-8 1 3 PLS ici ,1.7i: Uti'A 92_6 7 (Street) q 2- 053 (City/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE DESCRIPTION TOILETS •••••••• :�J♦x,'�:; `••` `•::``::::::%:c:::::::.c:•,,.t.:.<;:•:}:':\` ;`:.:y<4{G::t%:fix;:: Ti ;•:+'-}}:;v:J}}}:•}}.v-:�:::: }:;:ViisO}Ji-:;::tl}}}:ptt{�i.,�:}x,VJr}}:•?�{t•Y.t i:•}S }}:y';•{i: k:i}�I�.•{'� ti::ij:v}iijj:�;i:ii'. SHOWERS ?`..ixY ?k?: Y:,•,.:rv:}:::::::•:::,o-ra:.o}:}}}}}}x.:r.•:?•?}.✓;x�};,'}a�tS3,�, . KITCHEN SINKS r y r•.}x+tr,.r:: n Ayy: w:: .?::ii ii{j;Y.{p•:;.;?:::i^;•YS}}N �$W.:-:i�Ki}:h'•}�'-'•iy:•r:�•''{r:�.i-:.i{t:•{:i?.,.:ti;•.i.}r:,Y., ''•'�C. f•An::Lti-:':L�YiLr;i<.v}vi}i>-ii?i:>.�?iitifi'.:ii:•if}i::'^;: 15�::l•:VIN.}?;".•:.tt�•a�;-ti•3:•ttxo}.3,-.•r„'-v.•"t:�:•`.•r:::;'.iS:::•: vHfr!F•J,.};:}::.:.: ,•?t:y;;j;;; GARBAGE DISPOSAL UTILITY SINKS • FLOOR DRAINS ::}...;. ,t;'.5R`t, :,•::Cf;ti.,,f:;:•fi.:t:<:•:5.%;,-;?:;:;•}Y..':t:t.':r•:;`.�..::p::.,;}tr.}.}-xfi•{:{:v: -:.Y,... •`iii:-• •,'::} .9..{. } k`-•••.•..::-:,.,.:i�?:'ax:}::,s,:::•':35:::•.••Y: :{,W,•}x•:t?-:a, ... •..:•}}}:?;;v}}}:.•xvxY.•'.x•.wi-,L+:: x.;vvx:.vv.:,:i w:+hv:.,x,•.•r-•.6:::.vnv}}x-.?•TY }}::•}:{•:t iC::.?.... BAR SINKS y«:�;.::?r:.,:;;;;.,::.x.}:;?•}:.Y.}:;<•}},:ttxz:%a>:r::,x>::�::K,::::;;,,,:,.o.�:}c::::•};-a?};•:�::::%�''....x.,....,•;.}}..�•x:s-v:-::}. /+y � -.;�.. •Y.-i4Y •; �s %•.r•: -}.+C 4•}:: - .iYf3 i�:}C�•;'r,'%J'n vYt^�.••t}:•:,i•^:: k ,; C}:t Y-' '•6f•.:::isrx;c{,'r:r:•:;;>`.inf:},,::tY:?;?}},::i:;}:`.>::rYt?:b;t:;.:t4`•:::>:}.; }}xtxt•:.•}:;•:oY:;asiS}s}}::isY.t::i;.o>i:,::}}xw�ar,�,•%}a✓.2`C+u}:,vSv:aY:%:::}}iS?.mw•<}:::•:xtt;a;,,•::::t-:.,,•:,,.::.w.a^»5}» xmx•:'t LAWN SPRINKLER — FOR EACH BACKFLOW DEVICE �.v?.:;.Y,•Yf.;:?:}rb:}::xt. ,{KY.::��xr��,«t- "'},s :' °; WATER SOFTENER DRINKING FOUNTAIN NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT y x6.00 = /2.u(, x6.00 = IA x6.00 = / x 6.00 = x 6.00 = x 6.00 = x 6.00 = x6.00 = x6.00 = x6.00 = 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 c.::" ,6 0 / 6,°x / G °' SUBTOTAL ,1< $ .4 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ a Vi,'L Spokane County Division of Buildings 13 511 West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 1