1992, 04-01 Permit App: 92002072 Plumbing Fixtures PLUMBING PERMIT APPLICATION FORM
9 I f r atickt Worksheet
JOB STREET ADD - , S: /�07 _�.�� qqA/
I •
CITY/ST �� �•.�� .�: .. i �r�-- - PARCEL NUMBER:
OWNER: iii.e.dgM ',:1OR /, i. . PH' UMBE : /
MAILING ADDRES'A / - ( 4 , e 41_ 44 I ( 4. q9.//IP
(Street) ity/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
TOILETS ] x 6.00 =
x6.00
=
SHOWERS;.;:.;;;:.:....................................................................................................... ` � x 6.00 =
A
x6.00 =
KITCHEN SINKS x 6.00 =
x6.00 =
:::..:....:.....::..::..:...:....:::.:..................... .
GARBAGE DISPOSAL x 6.00 =
x 6.00 =
UTILITY SINKS x 6.00 =
x6.00 =
FLOOR DRAINS x 6.00 =
x 6.00 =
BAR SINKS x 6.00 =
x6.00 =
LAWN SPRINKLER- FOR EACH BACKFLOW DEVICE x 6.00 =
x6.00
WATER SOFTENER x 6.00 =
x 6.00 =
DRINKING FOUNTAIN;::.:;;:;.........................................................:................. x 6.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$
SIGNATURE U d.i d 1_2_4* I ( "al 1
a
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675