1990, 08-15 Permit App: 90003938 Safety InspectionPLUMBINGIERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: /\_/,cg(_'1-t0
CITY/STATE/ZIP: rye-/ `/A- 99'2c PARCEL NUMBER: OWNER: �?02-0P lti r PHONE NUMBER: 5012$
or ke./ /(l 75%14'6.
MAILING ADDRESS:
A4-7-125 �� 23/City/State ) (Zip)
(Street)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(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 =
x 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 1= $
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675