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1992, 07-17 Permit App: 92005435 Lawn Sprinkler
PLUMBING PERMIT APPLICATION FORM r- a G 3 Information Worksheet JOB STREET ADDRESS: 4 / 5 ` A/ ' , A 4.--T-%.-, �C JGE CITY/STATE/ZIP: , . i 66}A...--‘ • PARCEL NUMBER: OWNER: 8. - (--. ....,..:11. ....,-,,,, PHONE NUMBER: y 0/- 7 - 2 ,i-,7 MAILING ADDRESS: (Stre (City/State) (Zip) � • CONTRACTOR:/ , •d Yt - .i t-.-t--� LICENSE NUMBER: / 1-5140 i.//.4 4 /D/ .2,J�1�, PHON NUMBER: 53.5^ 6P5-1;21 MAILING ADDRESS: / / "3i. :I` • 7,,,e1 :3 (Street) `(City/State) / (ziP) PLUMBING WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT TOILETS x 6.00 = ��r4 { .f..:; •:::}...r.t{.}Y.}:?•}::<:};;•<:v::::::�> _ X 6.00 1. ;:::i:::::i:4i;{{•:?.:t•}}}:•}%.iY:�:iFm'{•:{•}Y::i}:}i}}:•%•}i}:•}:J%4:_}:?^}ti:•{G}}}•}vi~'•'}f:';{i?t:''•i:�$}r':1111::1:3,.};:.Y. SHOWERS x 6.00 = .:YM}:•%•Y -.3:..h:::::ki i:Y:;-r.::::vii i?:-f,.?iR:i:.:.:?ri:}t,Y•E:s:{4:4}:::•Y,.$:�::::;xn<J:t}:i:}}'::: _ >:.}:{.}:•Y:,{{?:•:Y.}}:.:h.:?:.}:}.:§ f.YX.:r ..}'.%v, {{} ??v:::*:::v<;%><::t:>•: 6.00 - rify<,,f.'rr:,a£�w''.:;:f:;<..;::;•fd'.y:::%:x•'' ? :Yr:;:s:}::i� .::2?:{.::: :,-:..<}}::•.,•::•::::•: x Q{�.��::•�M��T:}{.r}'x:n....,'~fvn ::.<:X}:�:..:n.....n,.:v...:::::• -:%{...4i�ii::ri:is?:>ii:t �iiii�:>.:i%{iv:Y> iF!A. •:: :::•}i}}:^:•}i}:-}ii�:•}}}ii}}i}}}:h:-ii}:: vi:4}f.•:}Yi:^:�rrx:::: :: :.vv.:..:::.....:i•: .• KITCHEN SINKS x 6.00 = �Qn,},r rrr:::\:.?vr: n6. 0.::rv::::}::::::::r:::}:.}'.::'•:v:•v:}:v:{.:::v}},:':::ny}}v:?•i'4'•}: .tSk°tzWASt�iwR��.:}:{>..:•:x•.:•:::r._::::.�:...r....}.:}•:::...::.:.:}:t•::-:'-:.{..............:.....r.....:............. x 6.00 = GARBAGE DISPOSAL rx ;E; x < : %: : : } ,} ?N x 6.00UTILITY SINKS x 6.00 = .}},.}:}:g:*::.}:?,:t•}:.}:n, :?v:•}:G:}:.:}}?:§:v};: x 6.00 = �O:;V:�,�Tl I�I� ►: i�....\::.::n::::•:=.:::nn.:......x}:}}%h}}Yti}}}`:•}:�h::::•::•:... ;.}rte:•`{ �r!�:..r�.:. F rx�};•}::.Yr.:Y%•:::::,.:V::.:•...n....:.................. .} x 6.00 = � FLOOR DRAINS _ t{ %�::>.:;:;> :: .'i+. '•'{/..: .::v4.v ::.f..:}.4i ii'}.\?Iii::?Z•::}}:}h}.:: •00 = :.:;}<,•xvy{,,��..//?fryii3i:..ir':}t: ...@ii �::::� ':%J= ;::i:ox,,{},.w,..,,o`•'..: ..t}}}••}:a:::•}} x 6 ,VK' ?':ti{•::.i{4.rY+;.;\4n.:{\..:::<}rvt}}i{ei i{:{^:•}.Y:}Y:}i::::?t{R.:{i???: fi}iJAN .••�::•n{{. .\.:.v'tvu.,:},Y,.l.}.tv:•}:w:,•.:{::4:.rf..:.:::v:}. .:.....r::•:•%?4r4 Y::i'-:±' ::i;};>:.:{i;}:{:?:},i}%.};n:v:nn::vnuuw�f.{{.}}%�:•:?ti.::•.S.ti{rn•::::.x•:?v:4:•::.?w.ri:v ?irf':.v:?:f.};:"Y:}:}. ... BAR SINKS x 6.00 = 40:110-40:4".111111111451.111111.10 x 6.00 S X 6.00 - MigaiLAWN SPRIN_KL_ER-FOR EACH BACKFLOW DEVICE a;;eo'{ncw3?{^}:f{�.:axscgf..:y}•r:c'•...t:a...:e}::ur::. r�.•c•}Y:?'.Mic:-v;�:?•; .�� :.,',.v,.,.j fi.V \iCfr�'�c ':':v:b:Y.i-S-1:::1:;`1{1:':1:;1-�;v :�•`.'•• if,.+. r:<i3':::•}' x 6 = •'%�:.•'vY:.w`::«a:: ::N.:f::;%?.::•t.}};}}::}f:.,•:{?:iy:?i•:.-.:`?Zc:,;'1?z:;`:•:.: WATER SOFTENER x 6.00 = tiff;{ti•:••• .00 ?4:{n}}}%4:4:??•:ti•}}}ji%i.}%{{-:{Cit v?n{{iri•:f}%v vi��:iiv:{.~Ii:::?:i%i:::::::?i:?Yi:i:?{>:�:i} x 6.00 DRINKING FOUNTAIN - SUBTOTAL $ x 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