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1993, 01-15 Permit App: 93000238 Plumbing ReversalPLUMBING PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS5-Pe-4(A-k/ 5 • 7'S 0 Nm14P/Z _ CITY/STATE/ZIP: S &IU€. (cSf3 a PARCEL NUMBER: p OWNER: /J8 0 L 09 a PHONE :UMBER: / Z g— 0 394 MAILING ADE -=ESS: (Str_-z-) MAILING ADDRESS: (As i tylState) NUMBER: (Zi I (Street) (City/State)- (Zip) DESCRIPTION TOILETS PLUMBING WORKSHEET/FEE SCHEDULE SHOWERS KITCHEN SINKS 44,44:.,, ...................... _4, .. DISHWASHERS"\ :is; GARBAGE DISPOSAL CLOTHES V1/ASHER , _' UTILITY SINKS ELECTRIC WATER HEATERS '€1 FLOOR DRAINS:,;s FLO.ORiSl BAR$I�NIttS NS LAWN ISPRINKLE• F ,..-471,1,3,WEr WATER'SOFTENER' URINAL :M= . DRINKINGFOUNTAIN • NOTE: MINIMUM PERMIT FEE SIGNATU NUMBER OF UNITS' < '<"` X EACH -=.-±' UNIT' :r' •-' = AMOUNT; ::• ;>. :• 1-x6.00.- - `-z 6.00;: �%:' x6.00= x 6.00'=•. , x 6.00 = x 6:00 = x6.00 = x6.00 = ":X.6.00 . �_r: ..x6.00 ` `,- ,;yi�.. - .,?:'`. •-"- _ 44,44.._ -.. .. .. . - - `u' > : :. 1- I.<`, aauu t '+m^a"'4y *1-"'."..J-43"...4'1lti�i3O,g.,'.;i: <^i.y+�s 1 x.N...Xyt4. yg,m f a g W600 =.` kx 6.00T err b j,Jifla 6.0/�/0�- 2� �x6:VV .- ,X s.00• =- x 6.00'=: -x6.00._ 4;;;.F.._,. -yz i'":..,T.s`j 't.'s zrr� ' �x .Jt `:h_.y cai' .E . q,e..:..,r,x .. , * ,.[- n: -n' '1* -`,-'9, . 1?».. 5i -.`$,_r�-n =y' .• r--- . . . • :;i s -F. SUBTOTAL':,:= :=.i; `':M PLUS: PROCESSING FEE "" + S • 25.00 EQUALS: TOTAL PERMIT FEE DUE = 5 3S vd Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675