1992, 09-02 Permit App: 92007164 Plumbing FixturesPLUMBING PERMIT APPLICATION FORM
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Information Worksheet
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JOB STREET ADDRESS: J/a�d ci ;/TO / ,�Q�
CITY/STATE/ZIP: felitw ' `i d9 (9S_9/6 PARCEL NUMBER. `7'Sf5 2- fOWNER: �if�V ,Av4t'1A1 PHONE NUMBER:?y 9£'�j
MAILING ADDRESS: S,4f
treet) i (City/State) (Zip)
CONTRACTOR: Jr.., ii I Au dA/ /_ / CENSE NUMBER: /0s77r�,l 0IG 5)9,72 {)
HONE NUMBER: r -X -C7 5"7
MAILING ADDRESS: / 217 /5 l // 1�'I )i /fig�im.9N Ze G/9 , 99. _
(Street) L (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE •
DESCRIPTION
TOILETS
SHOWERS
KITCHEN SINKS
GARBAGE DISPOSAL
UTILITY SINKS
TER
A
FLOOR DRAINS
........................................
BAR SINKS
LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE
WATER SOFTENER
...................
DRINKING FOUNTAIN
NOTE: MINIMUM P ' M FE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x6.00=
x6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x6.00=
x6.00 =
x6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x6.00 =
x6.00 =
x6.00 =
x6.00=
.
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_$
SIGNATUR
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675