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1990, 01-25 Permit App: 90000327 Plumbing Fixtures • a Y PLUMBING PERMIT APPLICATION FORM Information Worksheet • JOB STREET ADDRESS: (�) 1 ) L < .N A V L W h t> X27 CITY/STATE/ZIP: )c IA-'ts. Ws4 PARCEL NUMBER: OWNER: e tom S PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: `-- N- 1— N-4.--\c- LICENSE NUMBER: LL U,ti 1)-3 �g PHONE NUMBER: MAILING ADDRESS: irl0`l pL�oK'� K j c =- O 7 (Street) (City/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE NUMBER OF X EACH DESCRIPTION FIXTURES FIXTURE = AMOUNT TOILETS \ x $6.00 = (,_A o SINKS k x 6. 00 = (, .,o d SHOWERS 1 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 x 6. 00 = SEWAGE EJECTOR x 6. 00 = WATER SOFTENER x 6. 00 = URINAL x 6. 00 = DRINKING FOUNTAIN x 6. 00 = SUBTOTAL $ 1cZ..00 PLUS: PROCESSING FEE + $ 25. 00 1 EQUALS: TOTAL PERMITI NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE $ k-"-3_0o I $ SIGNATURE Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (5 9) 456-3675