1993, 05-11 Permit App: 93003374 Sprinkler Systemet? c2,e.c,c- cdtx,„
S- -- PLUMBING PERMIT APPLICATION FORM 2S2�
information Worksheet
Le -1
JOB STREET ADDRESS: / v r -c / LOCD S %
CITY/STATE/ZIP:L >Ay( (2'9 • PARCEL NUMBER:
OWNER: _ , /
,P/t/ er 2?-1-7C/Wier ar PHONE NUMBER: t > r
MAILING ADDRESS:
�7:�t f -{O me r3L,' m y
//ff�Street) (City/State) (Zip)
CONTRACTOR:,H9/4ZSAO//'�5 LICENSE NUMBER:YLL 0m6 B
7 99'�U
PHONE NUMBER: /
MAILING ADDRESS: / `� 3x CC) ` ' (CCJ r9�APn S &/ 4 • 97
(Street) (City/State) (Zip) •
DESCRIPTION
TOILETS
SNI.
SHOWERS
t3liTH_TIJSS <': N
KITCHEN SINKS
!Stl WASH
GARBAGE DISPOSAL
UTILITY SINKS
E[ C7( CG VJ nti
FLOOR DRAINS
IF OOI3SINKS
FLQQu A<r�...,
BAR SINKS
rR. UORDRAINS.<•
•. _.
LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE
>Sr WAG>t JECTLyn ..:::,..>.. < w ::M•:,< ..,=:;<::::: ,::_:::. .
WATER SOFTENER
URINAL
DRINKING FOUNTAIN
PLUMBING WORKSHEET!FEE SCHEDULE
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 =
NOTE: MINIMUM PERMIT FEE
SIGNATU
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Spokane County Division of Buildings
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