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1991, 09-03 Permit App: 91005483 Plumbing Fixtures PLUMBING PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: 2� /Z .�. /.////- g- 3O ` q ,,TY/STATE/ZIP: spa,-Gine 1,/4• PARCEL NUMBER: OWNER: ti/avid �IILGa.s/ice PHONE NUMBER: MAILING ADDRESS: / ' (Street) (City/State) (Zip) CONTRACTOR: 3h1/ 7roineri 1 �rvl�J LICENSE NUMBER: Sill IT 3CU� C)4 PHONE NUMBER: ii`/g -8?8 MAILING ADDRESS: -7/0 �c,��dl�s e �o% � o�c�f�r 4/4- Z_Yc.( (Street) (City/State)- (Zip) PLUMBING WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT = AMOUNT TOILETS / x 6.00 = SINKS: ...... x 6.00 = SHOWERS x 6.00 = x 6.00 = KITCHEN SINKS x 6.00 = DISK WASHERS x 6.00 = GARBAGE DISPOSAL x 6.00 = CLOTHES 41ASHER:.: .: .;. .: x 6.00 = UTILITY SINKS x 6.00 = ELECTRIC WATER.HEATERS x 6.00 = FLOOR DRAINS J x 6.00 = FLOOR SINKS.. x 6.00 = BAR SINKS x 6.00 = ROOF DRAINS.. .: .. x 6.00 = LAWN SPRINKLER x 6.00 = SEWAGE EJECTOR x 6.00 = WATER SOFTENER I x 6.00 = URINAL x 6.00 = DRINKING FOUNTAIN x 6.00 = SUBTOTAL $ 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