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1993, 04-16 Permit App: 93002583 Lawn Sprinkler SystemPLUMBING PERMIT APPLICATION FORM Information Worksheet ,JOB STREET ADDRESS: R,)b CITY/STATE/ZIP: 6 1,0 ,4 4: 1 ,21)1 PARCEL NUMBER: OWNER: j h PHONE NUMBER: MAILING ADDRESS: bi (Street) - 9 (Zip) (City/State) CONTRACTOR: (1: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: ; 27 1 .2 t- S -f• (Street) Sie<C• (City/State) (zip) PLUMBING WORKSHEET/FEE SCHEDULE DESCRIPTION TOILETS *M13- „ "1;1 4..i..k SHOWERS KITCHEN SINKS • • xi.,,t/tt9.}.t.3.:ttt,7IX::•.,,,,y•fp:•••:•:,./tt,t• GARBAGE DISPOSAL :141: UTILITY SINKS •.• FLOOR DRAINS • .,„*.:-3:t4, '4A -V:014 BAR SINKS ROOP •PiXteni: zw4WPSWPA ikbAtialai LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE w---"Wdrdare...„ 743 ' 'As.ktfigA.,:..VANE-Mgy kgv*sk4U. ii:?rnst*ItiftVW.o WATER SOFTENER 33,:tt.3,:ttt:3:t4dcttntl • G DRINKING FOUNTAIN NOTE: MINIMUM PERMIT FEE IS $35.00 / SIGNATURE "44/ ( ,e -Z,1/? NUMBER OF UNITS X EACH UNIT = AMOUNT x6.00 = x6.00 = x6.00 = x6.00 = x6.00 = x6.00 = x6.00 = x6.00 = x 6.00 = x6.00 = x 6.00 = x6.00 = x 6.00 = x 6.00 = x 6.00 = x6.00 = x 6.00 = x6.00 = x6.00 = / SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 5±3_ ()(-% Spokane County County Division of Buildings