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1993, 05-18 Permit App: 93003620 Lawn Sprinkler Systemr PLUMBING PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS. ' ?`1/ S ?$s/L CITY/STATE/ZIP:_�� ZK _ WA ' ZOCo PARCEL NUMBER: OWNER: PHONNUMBER: G}Z.ry - 5 Z7— MAILING Z . MAILING ADDRESS: �✓'__ • (Street) �/ / (City/State) ,,/ (Zip) CONTRACTOR: Naar !✓i'?'" L -A/t7S(G/✓ LICENSE NUMBER: /vD ILW.2 OgSL4 PHONE NUMBER: qZ!. - ' j 1 CI MAILING ADDRESS: qd// Z7`-‘ %'4 4E., 14/14- q7-0 (Street) (City/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE DESCRIPTION TOILETS i'???•�i vy:4:i 5i SHOWERS b:•::w;y.•:a+a+:at as KITCHEN SINKS IAI GARBAGE DISPOSAL • UTILITY SINKS FLOOR DRAINS TTAF+:G%i�fiAyW"YXd4'i++y++' A:+AC.•N:.�J BAR SINKS 4+ •'••}mph++`] LAWN SPRINKLER • WATER SOFTENER DRINKING FOUNTAIN FOR EACH BACKFLOW DEVICE NOTE: MINIMUM PE:#06E IS $35.00 i SIGNAT a���if�� (11 NUMBER OF UNITS X EACH UNIT = AMOUNT x6.00 = x 6.00 = x 6.00 = x6.00= x6.00 = x6.00 = x 6.00 = x6.00 = x 6.00 = x6.00_ x6.00 = x 6.00 x6.00 = x 6.00 = x 6.00 = x6.00_ x6.00 = x6.00 = x6.00= 6,.o0 SUBTOTAL $ (,. X) PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT f'�� FEE DUE _ = $ 2f-�dce Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675