1995, 06-12 Permit App: 95004191 Sprinkler SystemPLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: E •/b 9z. t W0/Zq//N(,<5470E_
CITY/STATE/ZIP: ,cpok1i-nir PARCEL NUMBER:
OWNER: NLcwp6 Y Cu57-0M to.+sT PHONE NUMBER:''"• -
A Lt7"o 2C -1-S Fn A•
MAILING ADDRESS:
(Street)
CONTRACTOR: Afro-
MAILING ADDRESS:
(City/State
•
LICENSE NUMBER: /4cge..4C?% 't) J /4
PHONE NUMBER: ,3LG' 9.494
/31/ N- LJAS# o' sro ri
(Street)
•
4-
ok.a r c' Z l `'`97ta /
City/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- SPRL- iuER
SEWAGE EJECTOR
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 =
V.0 cr onom
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL%PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE'DUE
SIGNATURE ✓�C/(%1*-
Spokane County Department of Building and Safety'
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675