1992, 08-24 Permit App: 92006769 Plumbing FixturesPLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: F, /Os -1.D ` /Y1/4 (A
CITY/STATE/ZIP: ,5P?L401. e.,
OWNER:-YitTct..\
MAILING ADDRESS: L 0 .S/S u4
PARCEL NUMBER:
PHONE NUMBER:
(Street) (City/State) (Zip)
CONTRACTOR/Y) ST'»JC LICENSE NUMBER: WY1STF: 1'-(I—Kin')
PHONE NUMBER: qa4- %710
MAILING ADDRESS: Qb tR- Cx 195cLSLI 114\1_ q9? -/t/
(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
SEWAGE. EJECTOR.
WATER SOFTENER
DRINKING FOUNTAIN
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
1
x6.00 =
x6.00 =
6,60
/
6,Dv
/
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 =
(0 0D
SUBTOTAL
$ a 1$00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
.$ 9,- d D
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675