1992, 04-10 Permit Application: 92002399 Plumbing FixturesJOB STREET ADDR
ITY/STATE/Z11P
OWNER:
MAILING ADDRESS
PLUMBING PERMIT APPLICATION FORM
Information Worksheet
=e192j/6 PARCEL NUMBER: V 7SY/ ^ /A�Y
PHONE NUMBER: 4aW.
'✓/� o r. zl� —
(Street) (City/State) (Zip)
CONTRACTOR: Ap LICENSE NUMBER: �- —
.C3 PHONE NUMBER: �9y/
MAILING ADDRESS:
(Street) (City/State) - (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE
WATER SOFTENER
DRINKING FOUNTAIN
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
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 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675