HomeMy WebLinkAbout1992, 07-24 Permit App: 92005676 Plumbing ReversalPLUMBING ERMIT APPLICATION FORM
Infornatiori' Worksheet
JOB STREET ADDRESS: Ids/cD Go 4 ) -e
CITY/STATE/�ZIP:5Q D 1----Q &X_
OWNER: (�O r`'( /c /Ce
MAILING ADDRESS: £- `4 c)- 6 w (5 2c) _ (JJI 9�,02 d b
(Street) (City/State) o(Zip)
CONTRACTOR: f r,7/ -e LICENSE NUMBER: t C i p\ sc p eo M ",
PHONE NUMBER: g02? - Cfa ko
j
E. MAILING ADDRESS: C . //,3c w c S. 61
(Street) (City/State) (Zip)
PARCEL NUMBER:
PHONE NUMBER:
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
TOI LETS
SHOWERS
KITCHEN SINKS
GARBAGE DISPOSAL
UTILITY SINKS
TEIzt
FLOOR DRAINS
BAR SINKS
LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE
WATER SOFTENER
.......................... .
DRINKING FOUNTAIN
ry\ Sc
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
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 =
x6.00 =
x6.00 =
x 6.00 =
x 6.00 =
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