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1992, 03-30 Permit App: 92002003 Sprinkler System
PLUMBING PERMIT APPLICATION FORM Dfp' Information Worksheet JOB STREET ADDRESS: c 1 ?SOLI ax W QJ 1 CITY/STATE/ZIP: 5?ok:vri-t: l) q q 2.0 l7 PARCEL NUMBER: /6 7 (- 6 1S21 OWNER: uPHONE NUMBER: MAILING ADDRESS: pug L, 6y (Street) CONTRACTOR: ).--ondSc S.1 02c (Street) MAILING ADDRESS: (City/State) (Zip) LICENSE NUMBER: PHONE NUMBER: 4 &Lo7 (DPg1 spa 1 _A Pc. 9 9 2-010 (City/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE DESCRIPTION TOILETS SINKS SHOWERS :B'ATH.TUBS:.- KITCHEN SINKS :DISH WASHERS GARBAGE DISPOSAL CLOTHES WASHER UTILITY SINKS 'ELECTRIC WATER' H EATERS FLOOR DRAINS FLOOR SINKS`:''.i. ir. BAR SINKS ROOF DRAINS. LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE 0 SEWAGE EJECTOR.'' WATER SOFTENER URINAL:_ DRINKING FOUNTAIN NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 6.00 = x 6.00 = x 6.00 = 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 = SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 tNLjj9) \-�(dS-°