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1990, 08-31 Permit App: 90004336 Plumbing FixturesPLUMBING PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: 4F, //‘a5- -A(06-4°F/12,4-2- g4 — i(C.S4 CITY/STATE/ZIP:.SPdPANE> UJ,4. 9?Z0(PARCEL NUMBER: OWNER: DEL v//Y /p Sc/ /!.D BEaf G PHONE NUMBER: MAILING ADDRESS: s- ,f / D'Ee .572).4- S/' A:4We , WA 79 20 (City/State) (Zip) CONTRACTOR: (Street) MAILING ADDRESS: LICENSE NUMBER: PHONE NUMBER: (Street) (City/State) (Zip) 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 = NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE SUBTOTAL PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE 17 $ OZa Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 Spokane_ County DEPARTMENT.OF BUILDING & SAFETY West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 INFORMATION WORKSHEET PARCEL NUMBER: STREET ADDRESS: /,/> 0 S v° / / CITY/STATE/ZIP: 59O K4,V-- WA 5.%/, ?2 0 4t3 -e -j'2' SUBDIVISION: BLOCK: LOT: ZONE: DISTRICT: LOT AREA:__ F/A: WIDTH: DEPTH: R/W: # OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT: OWNER: p %' L (/ / 4 e, 54/dei---/PG MAILING ADDRESS: `Yo s/.37 PHONE: .-C) ? - F �/ - .3 9 2 CITY/STATE/ZIP: s'PQ /C.4 it/L-- W fr, 5 l f{. 992D6 CONTACT: PHONE: SETBACKS: - FRONT: LEFT: RIGHT: REAR: PERMIT USE: ***********,t********+**************+k+IFic********************+k*icfc*iE************ BUILDING INFORMATION CONTRACTOR LICENSE NUMBER: CONTRACTOR: MAILING ADDRESS: ARCHITECT/ENGINEER: MAILING ADDRESS: PHONE: PHONE: NEW: REMODEL: ADDITION: CHANGE OF USE: DWELL UNITS: OCCUPANT LOAD; BIIILDING HGT: STORIES: BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT.: REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL: