1995, 02-03 Permit App: 95000568 Sprinkler System PLUMBING PERMIT APPLICATION FORM 4'4 : z A ,
Information Worksheet
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JOB STREET ADDRESS: / 0 LA/ -GJ-
CITY/STATE/ZIP: fPD�h'yL 4h4 99d0(p PARCEL NUMBER:
OWNER: ,_5?o7r Liuy PHONE NUMBER: r-9G5/ c ' ✓r
MAILING ADDRESS:
(Street) (City/State)-,',,,,,s s`(Zip)
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CONTRACTOR: �� - /2/I//y LICENSE NUMBER: /-G &/ZrC'f 1,-U� 4
PHONE NUMBER: 32_6_ ‘7yy.a
MAILING ADDRESS: /31/ N. U 3S f<A)(7Ta (Ni
(Street) (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE•
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• NUMBER OF X EACH ;n:` ;
DESCRIPTION FIXTURES FIXTURE = AMOUNT'
TOILETS x $6.00 =
' SINKS x 6.00 =
SHOWERS x 6.00 =
BATH, TUBS ,. x 6.00 �. .
KITCHEN SINKS x 6.00.
DISH WASHERS x 6.00 = ' >
GARBAGE DISPOSAL x 6.00
CLOTHES WASHER x 6.00 =
UTILITY SINKS x 6. 00 =
ELECTRIC WATER HEATERS x 6.00 =
FLOOR DRAINS x 6.00 =
FLOOR SINKS x 6. 00 =
BAR SINKS x 6. 00 =
ROOF DRAINS x 6.00
LAWN SPRINKLER f x 6. 00 = / 6 0
SEWAGE EJECTOR x 6.00 =
WATER SOFTENER _ x 6.00 =
URINAL x 6. 00 =
DRINKING FOUNTAIN x 6.00 =
GL-
CC (* L.' t SUBTOTAL $ r y . ,
PLUS: PROCESS;NG FEE + $,,25.00
EQUALS: TOTAL.PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE _ $ ;3 1j6 .
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SIGNATURE
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675.