1990, 09-18 Permit App: 90004669 Plumbing Fixtures PLUMBING PERMIT APPLICATION FORM
Information Worksheet Sy)
JOB STREET ADDRESS: S ` o� (3\ c\ A \"�
CITY/STATE/ZIP: tict\Lnivvc, UO4) Lq OLPARCEL NUMBER:
OWNER: 1d,_ 1� �. \ C .► PHONE NUMBER:(
MAILING ADDRE, : �, a( 1� C3 `i1/, Pd/ S QoUcu.ke cte0 OL
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER OF X EACH
DESCRIPTION FIXTURES FIXTURE = AMOUNT
TOILETS x $6.00 = •
SINKS x 6.00 =
• SHOWERS 1 x 6.00 =
BATH TUBS x 6.00 =
KITCHEN SINKS x 6.00 =
DISH WASHERS x 6.00 =
GARBAGE DISPOSAL x 6.00 =
CLOTHES WASHER x 6.00 =
UTILITY SINKS x 6.00 =
ELECTRIC WATER HEATERS x 6.00 =
FLOOR DRAINS x 6.00 =
FLOOR SINKS x 6.00 =
BAR SINKS x 6.00 =
ROOF DRAINS x 6.00 =
LAWN SPRINKLER x 6.00 =
SEWAGE EJECTOR 1 x 6.00 =
WATER SOFTENER x 6.00 =
URINAL x 6.00 =
DRINKING FOUNTAIN x 6.00 =
SUBTOTAL $
PLUS: PROCESSING FEE + $ 25.00
1
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE 1_ $
SI GNATURE e
Tiecl:WO9TA
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (5 9) 456-3675