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1992, 10-02 Permit App: 92008371 Lawn SprinklerPLUMBING PERMIT APPLICATION FORM E Information Worksheet E JOB STREET ADDRESS: i a ao a I Q rJo r A b r CITY/STATE/ZIP: fir>D f LJA 9ciaoPARCEL NUMBER: OWNER: GAr' fn A\er"o ij PHONE NUMBER: (--�� SL'* ADI 0s MAILING ADDRESS: Pi taafll—P-siOrA r (Street) , (City/State) (Zip) CONTRACTOR: Lees L,t Su4pitDC, LICENSE NUMBER: L2.es(-IO'©Q p PHONE NUMBER: Ciao " SO 19 MAILING ADDRESS: N O l to V ppb r V RE Str)44 AE uo A cA9 ab.C, (Street) (City/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE DESCRIPTION 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 - FOR EACH BACKFLOW DEVICE WATER SOFTENER ' URINAL DRINKING FOUNTAIN NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE 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 = 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 = 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