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1991, 09-18 Permit App: 91006001 Sewer ReversalPLUMBING PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: /V m ax Rcc.u=30 CITY/STATE/ZIP: (17,7‘4 7e, 109 99`a=v4, PARCEL NUMBER: OWNER: J 4 PHONE NUMBER: MAILING ADDRESS: /ft cV/8 / a.,� ei /el' V9 (Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State)- (Zip) PLUMBING WORKSHEET/FEE SCHEDULE DESCRIPTION TOILETS StiK� vhri- L{*YJ SHOWERS GARBAGE DISPOSAL - UTIUTYSINKS FLOOR DRAINS :i•}fia\:Svv ::iYxl6.6 s}' BAR SINKS-• - -- :10 -MEW ,s,44 LAWN SPRINKLER pfi 03,19 WATER SOFTENER DRINKING FOUNTAIN NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 6.00 = 4. ex:, x 6.00 = 4,,m x 6.00 = x 6.00 = 4.00 • x 6.00 = -... x6.00 = x6.00= ... ; x600 ;,, x6.00= x6.00_ x6.00 = x 6.00 = x6.00 = x6.00 = x 6.00 = x6.00 = x 6.00 = x6.00 = x 6.00 = SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _$ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675