1991, 09-24 Permit App: 91006188 Sump PumpPLUMBING PERMIT APPLICATION FORM
IWert-illation Worksheet
JOB STREET ADDRESS: //46_2 L . /`/ 4 /
CITY/STATE/ZIP: S °kiP/!P , (/ 1/2142 PARCEL NUMBER:
OWNER: -The t.JP P 7— F PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Zip)
(Street)
(City/State)
(Zip)
DESCRIPTION
TOILETS
SINKS
SHOWERS
BATH TUBS--
KITCHEN SINKS
DISHWASHERS `
GARBAGE DISPOSAL
CLOTHES°WASHER:
UTILITY SINKS
ELECTRIC WATER HEATERS
FLOOR DRAINS
FLOG SSINKS.
BAR SINKS
ROOF DRAINS
LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE
.SEWAGE EJECTOR --
WATER SOFTENER
_URINAL
DRINKING FOUNTAIN
PLUMBING WORKSHEET/FEE SCHEDULE
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
= $
0
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675