1989, 11-03 Permit App: 89004503 Plumbing FixturesJOB STREET ADDRESS:
PLUMBING PERMIT APPLICATION FORM
Information Worksheet
CITY/STATE/ZIP:
JU60 Fl ZG-- P CEL NUMBER: V 15 , 1 a,,
246,OWNER:6 Fy PHONE NUMBER: q2.- 1007
MAILING ADDRESS: E • '1 [
16-2-71, o h) �l l tZl�o
(Street) (y/State) (Zip)
CONTRACTOR: -s-V_ LI CENSE NUMBER: -dX - 7;240 -
PHONE NUMBER: q-1170 T
MAILING ADDRESS: 1' U i 3,107 6192410
y/State.; .. _._. ., (zipy_
(Street)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
NUMBER OF X EACH
FIXTURES FIXTURE
= AMOUNT
TOILETS
SINKS
SHOWERS
BATH TUBS
KITCHEN SINE
DISH WASHERS
GARBAGE DISPOSAL
CLOTHES WASHER
UTILITY SINKS
ELECTRIC WATER HEATERS
FLOOR DRAINS
FLOOR SINKS
BAR SINKS
ROOF DRAINS
LAWN SPRINKLER
SEWAGE EJECTOR
WATER SOFTENER
URINAL
DRINKING FOUNTAIN
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 IS $35.00
SIGNATURE c/) — l p (ALJ
Spokane County Department of Buildin-qq and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
$ 1060
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE