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1991, 07-16 Permit App: 91004239 Plumbing Fixtures
PLUMBING PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: �N v l 2 \ V t C. CITY/STATE/ZIP: % .) 0 Wl.. c- q 2 1 9 PARCEL NUMBER: OWNER: U ' MAILING ADDRESS: .0 \ 7 17 \ ( 7 (StreeI) OO1 "RAC' is PHONE NUMBER: -C 3 ` 1 ) 9 A- GP' 203 (city/State) (Zip) UT -E NUrMBER: _. NUMBER: MAILING ADDRESS: (Street) (City/State)- (Zip) PLUMBING WORKSHEET/FEE SCHEDULE ii-bc-r)-z ey_F 76;x_ TOILETS. ,SINK SHOWERS KITCHEN SINKS GARBAGE DISPOSAL :art f..:{{�:{ ,{...vr,.• .... .{{ri Xa.4•vsh•{-Y{{�+h{vi&%4idtah�➢{aaS:ai4]i UT•}ILITY SINKS EATER H FLOOR DRAINS zi:cax�x::�:«.s.,..acScaP ww� BAR SINKS,. -• _ - .•;vim ::.:�t: Maa aF}.\vvv:{ah a.f+ vCK kdY.ti+'C':vG+rii+:xatiaYAta} (• •. • <.4.4. LAWN9.SPRINKLER c'rYiox�< ti•:{�{v]4lii{:24C{ai:iM <vw6C{'v}:at-Yrii4i9it{vi-iv'a WATER SOFTENER DRINKING FOUNTAIN NOTE: MINIMUM PERMIT FEE IS $35.00 X SIGNATURE (A -64\k% kjkA, 1J NUMBER OF UNITS >° X EACH UNIT = AMOUNT . 2... x 6.00 = x6.00 = x 6.00 x6.00= x 6.00 = x6.00= x6.00 = X 6.00 .-- 1 1 Z' 2 G- '1 S t. x 6.00 = x6.00= x6.00= x6.00= x 600=sr• x6.00.4 x 6.00 x 6.00 = X 6.00 = x6.00= x 6.00 = SUB $ ti 2- PLO'S* ESSING FEE + $ 25.00 UALS: TOTAL PERMIT FEE DUE G 7 $ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane. WA 99260 (509) 456-3675