1989, 10-24 Permit App: 89004264 Plumbing FixturesPLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: / 5.//
CITY/STATE/ZIP: PARCEL NUMBER: ///"/-3'-. 2-C/3
32— c�'
QS
OWNER: A/C) ✓' RA Se -c2
MAILING ADDRESS: Sw41nti.e_
PHONE NUMBER:
//A� 1� (Street) (City/State) n r (Zip)
CONTRACTOR: lei l«/U.u4lJ at:45 LICENSE NUMBER: QAiX7 /a /S ar
n/A PHONE
%% NUMBER: ��� / US -d00
MAILING ADDRESS: E /1$76.2 �'V ( ceasce ldl #co & V tz1--
(Street) (Cit/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
NUMBER OF
FIXTURES
X EACH
FIXTURE
= AMOUNT
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
SEWAGE EJECTOR (SA -ca./ JL.f
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 =
_c
e.9-2
NOTE: MINIMUM PE T FEE IS $35.00
SIGNATURE
SUBTOTAL
$
PLUS: PROCESSING PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 3 C5" St
2
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675