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1992, 09-02 Permit App: 92007163 Plumbing FixturesPLUMBING PERMIT APPLICATION FORM Information Worksheet ofp ef OeJS JOB STREET ADDRESS: /-1/49/` .3 �, j r ti L5 114��� CITY/STATE/ZIP: ` r9/u�' G� c)(3,9l(, PARCEL NUMBER: OWNER: Z i) � ,=-/4r PHONE NUMBER:c 7 - 5/6 MAILING ADDRESS . ,� (Street) (City/State) (Zi ) CONTRACTOR: /.C>is/G,7AUi/1;5��_. elLICENSE NUMBER: /1-40 r=33/ V V 5)/)'J (1 PHONE NUMBER: e3cg, ---) X76 MAILING ADDRESS: /-7:9 j 3 Aft/p/c .-C. ,m /Q_,c../ /, Aix . .9 'C')49 € (Street) v (City/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE DESCRIPTION TOI LETS SHOWERS KITCHEN SINKS GARBAGE DISPOSAL UTILITY SINKS BAR SINKS LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE WATER SOFTENER DRINKING FOUNTAIN NOTE: MINIMUM PER T EE IS $35. %/ SIGNA •���'1 NUMBER OF UNITS X EACH UNIT = AMOUNT x 6.00 = x6.00 = x 6.00 = x6.00 = x6.00 = x6.00 = x6.00 = x6.00 = x6.00 = x6.00 = x 6.00 = x6.00 = x6.00= x6.00 = x6.00 = x6.00 = x6.00 = x6.00 = 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