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1990, 04-12 Permit App: 90001436 Plumbing FixturesPLUMBING PERMIT APPLICATION FORM InformationJWorksheet JOB STREET ADDRESS: S areC /1194q �4RRB�U CITY/STATE/ZIP: f3Kt4iD PARCEL OWNER: `,e 1104��+r'��Z PHONE MAILING ADDRESS: �q/L('G as A6,cg NUMBER: NUMBER: go? (1-66V1 (Street)] / r SEN CONTRACTOR: 442.1 VI ✓r / LIC SE PHONE MAILING ADDRESS: ti 70 g c (Street) (City/State) �j (Zip) NUMBER:ef(P1i NUMBER: p 4 -#-/30-6- 044)6, len f 9,ao7 (City/State) (Zip) NOTE: 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 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 = �, / CPC7 / kE'r— / h ti MINIMUM yER 'P FEE 5.0 SUBTOTAL $ I a o© PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ A 1 SIGNATUR Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260- (509) 456-3675