1992, 01-09 Permit App: 92000155 Plumbing FixturesPLUMBING PERMIT:APPDICATION FORM
Information Worksheet
JOB STREET. ADDRESS: l / 2zv
CITY/STATE/ZIP: - PO(lAnf j
OWNER: T Ler&' 1 PHONE NUMBER:
MAILING ADDRESS:
PARCEL NUMBER:
i\ -10(q. ✓LJP x- t i - " L
/7003
(Zip)
CONTRACTOR: 10 (Ant bC. R: A) o I11 N 1 L l b
PHONE NUMBER: %
Siqn*(q-isNi 02--)1")(City/State)
treat) (City/State)
J -n i a-
MAILING ADDRESS:
LeJ
(Street)
Hv LICENSE NUMBS
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
SEWAGE EJECTOR
WATER SOFTENER
URINAL
DRINKING FOUNTAIN
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
4
x6.00 =
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