1989, 07-21 Permit App: 89002360 Plumbing FixturesJOB STREET ADDRESS:
CITY/STATE/ZIP:
,' 1'
PLUMBING PERMIT APPLICATION FORM
Information Worksheet
5-- /Gal .
OWNER: 4 v £8_L. 2j
MAILING ADDRESS: S -/t' 7 dCJZvrr" !ir /U
(Street) (City/State) (Zip)
PARCEL NUMBER:
PHONE NUMBER: .92P -'2-y7
CONTRACTOR:
MAILING ADDRESS:
LICENSE NUMBER:
PHONE NUMBER:
(Street)
(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 =
/
/
I
/
/
MINIMUM PERMIT FEE IS $35.00
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ &/, CO
SIGNATURE
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675