1990, 01-22 Permit App: 90000261 Plumbing Fixtures PLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: E 160 -7 Ke )(m- /A ,/
CITY/STATE/ZIP: ‘ .1 )llg LUA 4?0,2 ,PARCEL NUMBER: '2-7J�' `�"/"-/��
OWNER: /`�'n��� 7D C/P/ T-L C a PHONE NUMBER: 9Z y 14073
MAILING ADDRESS: Sc J/ 17 ,1kr A vrfi��r/Ac,4U4 7z��c
(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 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 x 6.00 =
WATER SOFTENER x 6.00 =
URINAL x 6.00 =
DRINKING FOUNTAIN x 6. 00 = 4.204
i
/SC SLE - SUBTOTAL $ i
PLUS: PROCESSING FEE + $ 25. 00
I
EQUALS: TOTAL PERMIT
NOTE: MINI• RMIT IS $35.00 FEE DUE 1 _ $ 3 -
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SIGNATURE ii / z 90
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Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675