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1993, 03-15 Permit App: 93001481 Plumbing Fixtures PLUMBING PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: CITY/STATE/ZIP: PARCEL NUMBER: OWNER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION • OT UNITS UNIT =AMOUNT TOILETS x 6.00 = .00 = SHOWERS 6 f x 1 x 6.00 = x 6.00 = KITCHEN SINKS ................................................................................. x 6.00 = x6.00 = GARBAGE DISPOSAL x 6.00 = = 6.00 UTILITY SINKS x:.............................................:............................................... x 6.00 = : ::><::<:<::::>:::< <:>> > >' >`:>:>:> <`>::>:::> x 6.00 = FLOOR DRAINS x 6.00 = xv.:V:•.}}:::x:;n}::::;:.ii}:•ii+:^::y:::::::.r..?Yi:.}'.:;.}.�:::ni•:::n�:::::::ni'p'Oi•:\.::ni}>:::.} = 1=�'Q�R>S' 1 ��.;.::.:: s....::.}}:..}:.�:,•::•:::::::•.�.,.:•::::::.:::.:.:•:.:�:•::.:;-::.::<.::.::;•:<;•:�:•::::.::::.:::::.:::.}:•::::.:::. x 6.00 BAR SINKS x 6.00 = i:00.0610010111111111111111111111111•111.1111111111111111 x 6.00 LAWN SPRINKLER— FOR EACH BACKFLOW DEVICE x 6.00 = SEWAGE �eyl :.::�.:••1 r:.;::}r}}:.-}}:<:;:;.::::<..:;>:::r:::<::>::>::;:<:::>>:;:>::><::>:::::::<::::>::::>::,::;':>•; x 6.00 •:r}rli::::4:v:r::::.:•:: ::: :::::: :::4 ::- :::: :}i:^^ WATER SOFTENER x 6.00 = >t�l�)�/k� >. �� ::,}rr��:�.::'`:.•.t: :,; x 6.00 F< DRINKING FOUNTAIN x 6.00 = SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT FEE DUE =$ SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675